https://ijmedicine.com/index.php/ijam/issue/feedInternational Journal of Advances in Medicine2019-05-24T07:15:08-06:00Editoreditoratijam@gmail.comOpen Journal Systems<p><span><span><img style="display: inline; margin: 6px;" src="/public/site/images/medip/ijam.jpg" alt="" width="134" height="190" align="left" />International Journal of Advances in Medicine (IJAM) is an open access, international, peer-reviewed journal that publishes medical news, original clinical research of interest to physicians in medicine, and reviews on all aspects of clinical medicine. The journal's full text is available online at http://www.ijmedicine.com. The journal allows free access to its contents. International Journal of Advances in Medicine is dedicated to bringing physicians the best research and key information. The journal has a broad coverage of relevant topics in the various disciplines of medicine. International Journal of Advances in Medicine (IJAM) is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, analytic reviews such as meta-analyses, insightful editorials, medical news, case reports, adverse drug reactions, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new drug updates. The journal publishes all research study types, from study protocols to phase I-IV trials to meta-analyses, including small or specialist studies. It is published every two months and available in print and online version. International Journal of Advances in Medicine (IJAM) complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</span></span></p><p><strong>Issues: 6 per year</strong></p><p><span><span><span><strong>Email: </strong><a href="mailto:editoratijam@gmail.com" target="_blank">editoratijam@gmail.com</a>, <a href="mailto:editor@ijmedicine.com" target="_blank">editor@ijmedicine.com</a></span></span></span></p><p><span><span><span><strong>Print ISSN:</strong> 2349-3925</span></span></span></p><p><strong>Online ISSN:</strong> 2349-3933</p><p><strong>Publisher:</strong> <a href="http://www.medipacademy.com/" target="_blank"><strong>Medip Academy</strong></a></p><p><strong>DOI prefix:</strong> 10.18203</p><p>Medip Academy is a member of Publishers International Linking Association, Inc. (PILA), which operates <a href="http://www.crossref.org/" target="_blank">CrossRef (DOI)</a></p><p> </p><p><strong>Manuscript Submission</strong></p><p>International Journal of Advances in Medicine accepts manuscript submissions through <a href="/index.php/ijam/about/submissions#onlineSubmissions" target="_blank">Online Submissions</a>:</p><p>Registration and login are required to submit manuscripts online and to check the status of current submissions.</p><ul><li><a href="/index.php/ijam/user/register" target="_blank">Registration</a></li><li><a href="/index.php/ijam/login" target="_blank">Login</a></li></ul><p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="mailto:editoratijam@gmail.com" target="_blank">editoratijam@gmail.com</a>, <a href="mailto:editor@ijmedicine.com" target="_blank">editor@ijmedicine.com</a></p><p><strong><br /></strong></p><p><strong>Abbreviation</strong></p><p>The correct abbreviation for abstracting and indexing purposes is Int J Adv Med.</p><p><strong><br /></strong></p><p><strong>Abstracting and Indexing information</strong></p><p>The International Journal of Advances in Medicine is indexed with</p><ul><li><a href="https://journals.indexcopernicus.com" target="_blank">Index Copernicus</a> <strong>(<strong><strong>ICV 2017: 100.00, </strong></strong><strong>ICV 2016: 88.20, </strong>ICV 2015: 82.82, ICV 2014: 85.84, ICV 2013: 6.71)</strong></li><li><a href="http://imsear.li.mahidol.ac.th/handle/123456789/156150" target="_blank">Index Medicus for South-East Asia Region (WHO)</a></li><li><a href="http://www.scopemed.org/?jid=122" target="_blank">ScopeMed</a></li><li><a href="http://www.journalindex.net/visit.php?j=9620" target="_blank">Journal Index</a></li><li><a href="http://jgateplus.com/" target="_blank">J-Gate</a></li><li><a href="http://scholar.google.co.in/" target="_blank">Google Scholar</a></li><li><a href="http://www.crossref.org/guestquery/" target="_blank">CrossRef</a></li><li><a href="http://www.directoryofscience.com/site/4548845" target="_blank">Directory of Science</a></li><li><a href="http://www.journaltocs.ac.uk/index.php" target="_blank">JournalTOCs</a></li><li><a href="http://journalseeker.researchbib.com/?action=viewJournalDetails&amp;issn=23493925&amp;uid=r4bf18" target="_blank">ResearchBib</a></li><li><a href="http://www.icmje.org/journals-following-the-icmje-recommendations/" target="_blank">ICMJE</a></li><li><a href="http://www.sherpa.ac.uk/romeo/journals.php?id=2295&amp;fIDnum=|&amp;mode=simple&amp;letter=ALL&amp;la=en" target="_blank">SHERPA/RoMEO</a></li></ul>https://ijmedicine.com/index.php/ijam/article/view/1601A study of clinical profile and etiology ring enhancing lesion in CT scan brain at a tertiary care center2019-05-24T07:02:43-06:00Rahul Gandhi G.drrahulgandhigoud@gmail.comTaha Mahboob Ali Khalidtahamak@gmail.com<p class="abstract"><strong>Background:</strong> Confusion lies over the diagnosis when the patients show ring enhancing lesions of the brain on CT scan. Some consider it as tuberculoma while some consider it as cysticercosis. More studies are required to give clear picture of ring enhancing lesions of the brain. The objective was to study clinical profile and etiology ring enhancing lesion in CT scan brain at a tertiary care center.</p><p class="abstract"><strong>Methods: </strong>This study was conducted in the Department of General Medicine, SVS Medical College, Mahabubnagar district which is a tertiary care referral hospital in the state of Telangana. This study was done during the period from July 2006 to October 2008. A total of 50 cases were taken up for this study. After selecting the patients for the study, already prepared protocol was followed strictly for each patient. The protocol contained identification data, detailed history and examination of central nervous system and peripheral signs for tuberculosis and cysticercosis.</p><p class="abstract"><strong>Results:</strong> The males were more than the females and 14-24 years age group was most affected. The most common presentation of ring enhancing lesions was seizures alone in 72% of the cases. Out of these cases the most common presentation was generalized tonic-clonic seizure in 40% of the cases. Majority i.e. 45 had single ring enhancing lesion on CT scan of the brain. The most common etiology of the ring enhancing lesion was found out to be neurocysticercosis in 54% of the cases of ring enhancing lesions.</p><p><strong>Conclusions:</strong> Ring enhancing lesions should be considered in differential diagnosis of those who present with seizures in endemic areas like India. </p>2019-05-24T07:02:43-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1585Evaluation of echocardiographic variables in patients of chronic renal failure: pre and post hemodialysis-a single center prospective study2019-05-24T07:02:43-06:00Gaurav Gargdrgaurav.g9@gmail.comDevinder K. Vohradevinder.vohra@gmail.comSharvan Kumarsgrkumar024@gmail.comGanesh Singhgsingh@gmail.comAlka Srivastavaalkasrivastava@gmail.com<p class="abstract"><strong>Background:</strong> Cardiovascular disease is the leading cause of morbidity and mortality at each stage of Chronic Kidney Disease (CKD) around 30%-45% of patients of stage 5 CKD have advanced cardiovascular complications. Congestive Heart Failure is responsible for approximately 15% death in hemodialysis patients. Hence this study was done with the aim to evaluate the effects of Hemodialysis on various Cardiac parameters detected by 2D Echocardiography in patients with Chronic Kidney Disease.</p><p class="abstract"><strong>Methods: </strong>In this prospective cohort study, 54 patients with Stage 4 and 5 CKD were evaluated for various cardiac parameters by 2D Echocardiography before and after Hemodialysis and detailed characteristics of the patients were analyzed using SPSS version 16 and paired student t-test.</p><p class="abstract"><strong>Results:</strong> Among 54 patients with CKD, 9% (5/54) patients had stage 4 CKD while 91% (49/54) had stage 5 CKD. Hypertension was present in 81.48% (44/54) of patients and Left ventricular hypertrophy was present in 77.77% (42/54). 6 (11%) patients had associated pericardial effusion. Mean Pre and Post Hemodialysis Left ventricular end diastolic diameter (LVIDed) and Left ventricular end systolic diameter (LVIDes) was 50.38±4.16mm and 48.91±4.14mm; 33.54±3.29 mm and 32.58±2.80 mm respectively which was statistically significant (p &lt;0.001). Pre-HD Left atrial diameter was 34.20±3.81mm and it became 33.19±3.30mm Post-HD (p &lt;0.001). Left ventricular mass index (LVMI) was 136.70±35.91 g/m2 pre-HD and 125.54±29.35 g/m2 post-HD which is significant. Left Ventricular Ejection Fraction was 47.34±5.72% before HD and it became 48.82±4.56% after 6 session of Hemodialysis over 3 weeks which is statistically significant (p&lt;0.038).</p><p class="abstract"><strong>Conclusions:</strong> The present findings suggest patients with Stage 4 and 5 CKD who were on hemodialysis there was significant improvement in various cardiac parameters apart from increase in left ventricular ejection fraction, which may lead to decrease morbidity and mortality in these patients. <strong></strong></p>2019-05-24T07:02:43-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1577Human immunodeficiency virus and HBV co-infection: independent entities, together by coincidence?2019-05-24T07:07:20-06:00Ajay Mathurarvindguptadr@yahoo.co.inLaxmi Kant Goyaldrlkgoyal@gmail.comArvind Kumar Guptaarvindguptadr@yahoo.co.inNupur Hoojaarvindguptadr@yahoo.co.inR. N. Yadavarvindguptadr@yahoo.co.in<p class="abstract"><strong>Background:</strong> To ascertain the prevalence of HBV among HIV-infected, treatment- naïve patients visiting a tertiary care centre in Jaipur, Rajasthan, India.</p><p class="abstract"><strong>Methods: </strong>An observation analytic study was done at a tertiary care centre affiliated to medical college with retrospective analysis of the hospital data of 30 calendar months. During this period routine diagnostic screening of HIV infection and HBV infection was offered to every suspected patient admitted in hospital and every pregnant woman visiting antenatal care clinic. Patients with documentary evidence of HIV infection and history of Hepatitis B vaccination in last 30 days are not screened for these infections at our centre. The HIV screening was done as per NACO guidelines. The HBV screening was done using commercially available enzyme linked immunosorbent assay kits (ELISA) for detection of surface antigen (HBsAg).</p><p class="abstract"><strong>Results:</strong> The study prevalence of HIV infection was 0.11% (40/35289). The prevalence was more in male (0.45%) than females (0.06%). HBV was not detected in any of the HIV positive patient in this study. The study prevalence of HIV among pregnant females was 0.05% (10/22026).</p><p class="abstract"><strong>Conclusions:</strong> In this study, prevalence of HIV infection was 0.11%. The study prevalence of HIV among pregnant females was 0.05%. Other than pregnant women, maximum positive cases (13/30, 43.33% positive cases) were in the age group of 25-34 years (sexually active group). No patient had HIV and HBV co-infection. <strong></strong></p><p class="Default"> </p>2019-05-24T07:02:44-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1565Evaluating diagnostic value of clinical symptoms and signs for chronic sinusitis by CT-scan in patients admitted to Ardabil city hospital, Iran2019-05-24T07:02:44-06:00Tirzad Fouladvandt.fouladvand@gmail.comAkbar Pirzadehakbar.pirzadeh2018@gmail.comKhatereh Isazadehfark.isazadehfar@gmail.comAlireza Alipoura.alipour@gmail.com<p class="abstract"><strong>Background:</strong> Chronic rhinosinusitis (CRS) refers to inflammatory nasal and para nasal sinuses which last at least 12 weeks. Despite its high prevalence, it is not easy to diagnose, and clinical criteria and simple radiographs are not so sensitive. The aim of this study was to investigate the diagnostic value of clinical symptoms and signs for chronic sinusitis by Ct-scan in patients admitted to Ardabil city hospital, Iran.</p><p class="abstract"><strong>Methods: </strong>This descriptive cross-sectional study has been done on 83 patients with CRS symptoms who referred to ENT of Ardabil city hospital. The necessary checklist included information such as age, gender, clinical symptoms and CT scan findings were completed and analyzed by statistical methods in SPSS version 21.</p><p class="abstract"><strong>Results:</strong> Of all 83 patients, 55.4% were female and most of patients were in age group 30-39 years with 30.1%. Of all patients, 29 (35%) had positive findings in CT scan of which 72.4% were female. The highest rate of sinus involvement was in the ethmoid sinus. The highest positive predicted value was for nose congestion with OR=2.26 and the lowest was for facial pain and toothache each with OR=0.1.</p><p><strong>Conclusions:</strong> In general, clinical symptoms have a small predictive value in the diagnosis of sinusitis and should be evaluated with CT scan findings (15.7%).</p>2019-05-24T07:02:44-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1354Assessment of liver involvement in type 2 diabetes mellitus using fibroscan® and correlation with risk factors2019-05-24T07:02:45-06:00Alagesan .alagu14in@yahoo.co.ukSairam Kumarssairam2611@gmail.com<p class="abstract"><strong>Background:</strong> Non‐alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver injury. The most important predictor of mortality in NAFLD is the extent of liver fibrosis. Advanced liver fibrosis is associated with overall and liver related mortality. The upcoming non-invasive imaging modality for the evaluation of liver fibrosis is transient elastography (TE) (Fibro scan®). The aim of this study is to assess hepatopathy among diabetics using TE and to correlate the degree of hepatopathy with the associated risk factors.</p><p class="abstract"><strong>Methods: </strong>Type 2 diabetes mellitus patients were assessed for liver stiffness using TE. Liver stiffness was correlated with the associated risk factors. Authors recruited 100 patients from diabetic clinic in tertiary care teaching hospital.</p><p class="abstract"><strong>Results:</strong> About 55% of males and 39% of females had increased liver stiffness. 14% of males and 11% of females had severe fibrosis(F3-F4). Body mass index, waist circumference, fasting blood sugar levels, and liver enzymes, had significant positive correlation with liver stiffness whereas triglyceride levels, high-density lipoprotein levels, and duration of diabetes mellitus did not correlate with liver stiffness.</p><p><strong>Conclusions:</strong> Diabetic patients have high prevalence of NAFLD and advanced fibrosis. Those with obesity and dyslipidaemia are at particularly high risk. Type 2 diabetes mellitus patients with hepatopathy can be easily identified using TE scan eliminating the need for liver biopsy. The establishment of a national program for the recognition of NAFLD is essential to reduce the risk of liver disease progression.</p>2019-05-24T07:02:45-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1525Management of late hemorrhagic radiation cystitis in patients of carcinoma cervix with special reference to 1% alum irrigation and its safety: a clinical study in a tertiary care centre2019-05-24T07:02:45-06:00Sasanka Kumar Baruasasankagmch@gmail.comNabajeet Dasnabajeetdas14@gmail.comS. J. Baruahsaumar_barua@rediffmail.comRajeev T. P.rajeevtpuro@gmail.comPuskal Kumar Bagchipuskalkumarbagchi@rediffmail.comDebanga Sarmadebangasarma@gmail.comMandeep Phukanmandeepphukan@gmail.com<p class="abstract"><strong>Background:</strong> Radiation cystitis is a well-known complication arising from radiation therapy in pelvic malignancies. Haematuria is usually the main presenting symptom of radiation cystitis, which can range from mild to severe refractory and life-threatening forms. There are various forms of treatment ranging from intravesical instillations like alum, formalin, prostaglandins and pentosan sulphate; hyperbaric oxygen therapy to surgical treatment like cystoscopic fulguration, arterial ligation and cystectomy.</p><p class="abstract">Here authors aimed to find the efficacy of 1% alum irrigation in controlling haematuria due to radiation cystitis and to correlate its use with change in clinical status and biochemical parameters.</p><p class="abstract"><strong>Methods: </strong>This retrospective study was done for a period from July 2010 to July 2017 which included all female cervical cancer patients with intractable haematuria due to radiation cystitis. Only patients with normal renal function were included. Irrigation with 0.9% NS, hem coagulase and subsequently 1% alum irrigation were given. Failed cases underwent cystoscopic fulguration.</p><p class="abstract"><strong>Results:</strong> Average age of presentation was 59.79 years. Of the 34 patients 20 (64.51%) patients showed complete response, 4 (12.9%) patients showed partial response and 7 (22.58%) patients had no response to alum irrigation and cystoscopic fulguration were done in these cases. There was no significant change in vital parameters and biochemical parameters except increased prothrombin time (&lt;0.001).</p><p class="abstract"><strong>Conclusions:</strong> No standard of care therapy is presently available for patients with hematuria following radiation cystitis although there is big armamentarium of therapies. Authors found that 1% alum irrigation is safe and efficacious for these patients although normal renal function is a prerequisite. <strong></strong></p>2019-05-24T07:02:45-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1551Analysis of risk factors for falls in geriatric patients: a single institutional experience2019-05-24T07:02:45-06:00Osama Shukir Muhammed Amindr.osama.amin@gmail.comAsso Faraidoon Ali Aminleft41@gmail.comSaad Kazim Karimalkhazrajis@yahoo.comSaad Suud Shwanisaadsuud@gmail.comRaed Thandoonr.nino@outlook.com<p class="abstract"><strong>Background:</strong> In elderly people, falls have been recognized as one of the major causes of disability and potentially preventable mortality. Authors analyzed the incidence of falls in elderly diabetic people who have been receiving insulin therapy versus those on oral hypoglycaemic agents (OHGAs).</p><p class="abstract"><strong>Methods: </strong>This observational study was conducted at the department of neurology of Shorsh military general teaching hospital and its outpatients’ department, Iraq, from April 1<sup>st</sup> to September 30<sup>st</sup>, 2016. A total of 100 diabetic patients older than 65 years of age, who had a history of one or more falls, were included in the study. The duration of diabetes, mode of its treatment, and its complications all were analyzed in addition to the risk factors for falls.</p><p class="abstract"><strong>Results:</strong> Females (n=57) outnumbered males (n=43) and the mean age of the patients was (71.2±3.6) years. Increasing patient’s age, long-standing diabetes, poor glycaemic control, insulin therapy, and polypharmacy (of 3 and more antidiabetic agents) were significantly and statistically encountered and associated parameters for the risk of falls. The presence of additional risk factors for falls (e.g., previous stroke, alcoholism, cardiac dysrhythmia, and osteoarthrosis) augmented this risk.</p><p class="abstract"><strong>Conclusions:</strong> Diabetes and its treatment render older people more liable for falls. The longer duration of the disease and the higher patients’ age (which were the commonest risks) are irreversible and non-correctable parameters for falls. Further analytic studies are required to unveil the role of each risk factor authors have detected. <strong></strong></p>2019-05-24T07:02:45-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1707Prevalence of cardiac autonomic neuropathy in type 2 diabetes mellitus and its correlation with other microvascular complications in South Indian population2019-05-24T07:02:45-06:00Dharmarajan Paneerselvamdrpushpasaravanan@yahoo.comPushpa Saravanandrpushpasaravanan@yahoo.comPriya Malinidrpushpasaravanan@yahoo.comVasuki R.drpushpasaravanan@yahoo.comSubhasree S.drpushpasaravanan@yahoo.comPeriyandavar I.drpushpasaravanan@yahoo.comRajesh Kumar Meenadrpushpasaravanan@yahoo.com<p class="abstract"><strong>Background:</strong> In individuals with type 2 diabetes mellitus (T2DM) the presence of Cardiac autonomic neuropathy (CAN) increases the risk of severe hypoglycaemia, cardiac arrhythmias, silent myocardial ischemia and stroke. It is also associated with increased perioperative morbidity and mortality, even with minor surgeries in these patients. The present study was conducted to assess the prevalence of CAN in T2DM patients and to investigate any possible association between CAN and micro vascular complications.</p><p class="abstract"><strong>Methods: </strong>102 T2DM patients between the age of 30 years and 70 years, who attended outpatient department of Institute of Diabetology, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai, Tamil Nadu were included. All the selected patients underwent laboratory investigations, biothesiometry, fundus examination, and CAN assessment by CANS analyser.</p><p class="abstract"><strong>Results:</strong> A slight female preponderance was noted in the study, though it was statistically insignificant. Out of 102 patients, prevalence of CAN dysfunction was found in 82 (80.39%) of T2DM patients. No significant association of CAN was noted with duration of diabetes (p=0.772), HbA1c (p=0.827) and nephropathy (p=0.524). However, peripheral neuropathy (p=0.006) and retinopathy (p=0.03) were found to be significantly associated with CAN in T2DM patients.</p><p class="abstract"><strong>Conclusions:</strong> Prevalence of CAN in asymptomatic South Indian T2DM population was found to be 80.39%, with equal sex distribution and was most common in the 51- 60 years age group. Diabetic neuropathy and retinopathy were the most significant microvascular complications predictive of the incidence of CAN in T2DM patients.<strong></strong></p>2019-05-24T07:02:45-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1757Clinical profile of Dengue fever in an urban tertiary care hospital in South India2019-05-24T07:02:45-06:00Dhivya P.drpdhivya11@gmail.comMonica A.drmonicaanand5@gmail.comJayaramachandran S.chandru598@gmail.com<p class="abstract"><strong>Background:</strong> Dengue is among the most common flavivirus infections in the world. Today dengue ranks as the most important mosquito- borne viral disease in the world. Current estimates report that, at least 112 countries are endemic for Dengue and about 40% of the world populations (2.5-3 billion people) are at risk in tropics and subtropics. Annually 100 million cases of dengue fever and half a million cases of DHF occur worldwide. The clinical features are noted to be different in varying demographics of the world outlining the importance of bringing out data from different parts of the world, so clinicians are better equipped to anticipate the problems associated with clinical dengue.</p><p class="abstract"><strong>Methods: </strong>The study was conducted over a period of 2 years at a tertiary care hospital in urban Bengaluru, India. A cross sectional study of a total of 250 patients was done. They were diagnosed to be positive for dengue serology (NS1 or IgM) before including them in the study. Clinical features, haematological, biochemical and radiological parameters were assessed.</p><p class="abstract"><strong>Results:</strong> Out of 250 patients with dengue fever, the most common symptoms were fever (100%), headache (94.4%) and myalgia (97.2%). Bleeding manifestations were noted in 11.6% of the patients. Bradycardia was noted in 14.8% of the study population. Leukopenia was noted in 36% of the study population. Increased SGOT was seen in 59.6% and increased SGPT in 52.8% of the 250 subjects. The clinical outcome of the 250 patients of dengue fever was classical dengue fever in 86.8%, DHF in 11.6%, DSS in 0.8% and death in 0.8%.</p><p class="abstract"><strong>Conclusions:</strong> All patients with dengue fever present with fever. Other common features noted were headache, myalgia. Bleeding manifestations are to be looked out for. Rare but important features that a clinician must be vigilant to look for are bradycardia and leucopenia. <strong></strong></p>2019-05-24T07:02:45-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1683Oral clonidine versus intravenous fentanyl in attenuation of hemodynamic responses to larngoscopy and endotracheal intubation: a comparative study2019-05-24T07:02:46-06:00Rukmini G.dr_sreddy@hotmail.comSrinivas M. Reddydr_sreddy@hotmail.com<p class="abstract"><strong>Background:</strong> During endotracheal intubation, it has been observed that there is evolvement of the responses of the circulatory in nature. These are difficult to control using the IV anesthetic drugs. Hence various agents are tried to overcome this drawback. Objective of research work was to study efficacy of oral clonidine on hemodynamic responses compared to IV fentanyl while patients undergo larngoscopy and endotracheal intubation.</p><p class="abstract"><strong>Methods: </strong>The patients were allocated into two groups of 30 each. i.e. 30 patients in clonidine group and 30 patients in fentanyl group. All the patients received were pre-medicated with glycoprrolate 0.2mg, ondansetron 4mg and tramadol 1mg/kg body weight. Cardiovascular parameters (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure,) were recorded at the following intervals: pre-induction, after induction, at endotracheal intubation, one minute, three minutes and five minutes after intubation.</p><p class="abstract"><strong>Results:</strong> The heart rate was significantly more at various intervals in patients who belonged to fentanyl group and it was significantly lesser in clonidine group. The systolic blood pressure was significantly more at various intervals in patients who belonged to fentanyl group and it was significantly lesser in clonidine group. The diastolic blood pressure was significantly more at various intervals in patients who belonged to fentanyl group and it was significantly lesser in clonidine group. Similar was the case with mean arterial blood pressure.</p><p class="abstract"><strong>Conclusions:</strong> Clonidine has been found to be more effective than IV fentanyl in stabilizing the cardiovascular parameters. Not only that orally it is easier to administer and cost effective.<strong></strong></p>2019-05-24T07:02:46-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1656Factors affecting carotid intimal medial thickness in patients with rheumatoid arthritis, an analytical cross-sectional study2019-05-24T07:02:46-06:00K. M. Prabhuswamydrprabhu12@gmail.comM. Virgin Joenaprabhudoctr@gmail.com<p class="abstract"><strong>Background:</strong> IMT assessment as a non-invasive imaging test is quite widely used especially among RA patients, the clinical applications of using such knowledge is scarce, hence study was conducted to compare the carotid artery intima-media thickness (CIMT) in patients with rheumatoid arthritis (RA) with healthy controls also to study the correlation between duration of rheumatoid arthritis, the activity of rheumatoid arthritis and other factors influencing (CIMT).</p><p class="abstract"><strong>Methods: </strong>In analytical cross-sectional study, of 80 participants of RA and 40 healthy controls, “DAS28” was used to assess disease activity. Carotid intima-media thickness assessed using carotid ultrasonography.</p><p class="abstract"><strong>Results:</strong> Mean age of the cases and controls was 43.9 and 44.38 years. Subjects with duration of disease &lt;2 years, to 5 years and &gt;5 years were 35%, 45% and 20%. The mean carotid intima-media thickness was 5.61mm in controls, and CIMT was 6.11mm in people below 2 years and 7.08 mm in people between 2 to 5 years and 8.00mm in people above 5 years which was statistically significant. The mean carotid intima-media thickness was 5.61mm controls and 6.86mm in people with low, 7.00mm in people with moderate and 6.95mm in people with high disease activity, which was statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> Study findings revealed risk of increase in carotid intima-media thickness higher among RA patients in the later stages and can increase the patients’ susceptibility to cardiovascular events. The factors showing strong association with intimal medial thickness were the age and symptoms duration. <strong></strong></p>2019-05-24T07:02:46-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1665A comparative study of clinical profile, severity and outcome of acute coronary syndrome in women and men admitted to a tertiary hospital2019-05-24T07:02:46-06:00Yugandhar Tummalayugandhar4922@gmail.comMohamed Hanifahhanifah4u@yahoo.comB. Amirtha Ganeshyugandhar4922@gmail.com<p class="abstract"><strong>Background:</strong> Coronary artery disease (CAD) has emerged as a major health burden in developing countries. Many recent reports concluded that women with CAD have a worse prognosis than men and also with regards to invasive interventions when compared to men. In this study, author determined the comparative outcomes of ACS in women when compared with men.</p><p class="abstract"><strong>Methods: </strong>This study was conducted in a tertiary care hospital from November 2016 to March 2018. History taking, ECG, cardiac enzymes, 2D-Echo and angiogram were done to diagnose ACS and the appropriate treatment was given. The severity was assessed and compared the outcomes along with complications.</p><p class="abstract"><strong>Results:</strong> The total of 112 patients were treated for ACS, in which, 55 were females and the remaining 57 were males. Majority of the patients in both genders was between the ages of 51-60. In males, STEMI noted 50.8%, NSTEMI in 36.8%, UA in 12.2%. In females, STEMI is noted in 62%, unstable angina in 32.7%, NSTEMI in 27.2%. Six patients (11%) had mortality in the women group and one (1.8%) had died among men.</p><p class="abstract"><strong>Conclusions:</strong> Atypical presentation of ACS was more common in females. Women with ACS had higher complications and higher mortality than men. <strong></strong></p>2019-05-24T07:02:46-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1658Evaluation of hepatocellular dysfunction and its association with severity in dengue patients2019-05-24T07:02:46-06:00Chandrasekar K. T.arunkumarr@mgmcri.ac.inTarun Kumar Duttaarunkumarr@mgmcri.ac.inArun Kumar R.arunkumarr@mgmcri.ac.inLokesh S.arunkumarr@mgmcri.ac.inM. V. Pravin Charlesarunkumarr@mgmcri.ac.in<p class="abstract"><strong>Background:</strong> Dengue is a mosquito-borne infection that in recent years has become an important disease of international public health concern. Dengue virus infections and illness when symptomatic, that patients tend to present with a significantly wide variety manifestations. The aim of the study was to evaluate liver dysfunction in patients with dengue infections.</p><p class="abstract"><strong>Methods: </strong>The present study was undertaken as an observational cross-sectional study the period June 2017 to December 2018. The details of all patients with serologically proved dengue fever admitted in the hospital were reviewed. Data including routine blood count, liver function test (LFT), prothrombin time (PT), activated partial prothrombin time (APTT), abdominal ultrasonography was studied. Statistical analysis: Data was analyzed using SPSS version 21.0. Difference between proportions was tested by using chi square test. Pearson correlation coefficient was used to measure linear correlation between two continuous variables. A p value &lt;0.05 was considered</p><p class="abstract">statistically significant.</p><p class="abstract"><strong>Results:</strong> Majority of the study participants were in the age group of 16-30 years (57.5%) and were males (64.5%). Fever, Headache and joint pain were the most common symptoms noted among the study participants. Majority of the study participants were found to have elevated levels of SGOT (75.3%), SGPT (64.2%) levels and lower levels of</p><p class="abstract">serum albumin (68.6%) on evaluation. Statistically significant association was observed between elevated liver enzymes and presence of features of dengue haemorrhagic fever.</p><p class="abstract"><strong>Conclusions:</strong> Considerably high proportion of patients with dengue infection were found to have hepatic dysfunction in the form of deranged liver enzymes.</p>2019-05-24T07:02:46-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1669Prevalence of obesity and diabetes among health care physicians in Pondicherry, India2019-05-24T07:02:46-06:00Sethu Prabhu Shankardrprabhumd@gmail.comE. Uma Sudhanumasudhan1@gmail.comK. Harsha Vardhan Reddyrahulxssingh@gmail.comRahul Singhharshaallsmiles@gmail.comNeelakandan Ramyadr.ramyamd@yahoo.com<p class="abstract"><strong>Background:</strong> Non communicable diseases like obesity and diabetes are increasing worldwide, healthcare physicians are also not immune to this morbidity. The objective of this study is to find the prevalence of obesity and diabetes among healthcare physicians.</p><p class="abstract"><strong>Methods: </strong>The study was done at a tertiary care hospital in Pondicherry. All adult health care physicians of both sexes working in the hospital and giving informed consent to participate in the study were included. Pregnant physicians and those who are not willing to give written consent for participation in the study were excluded from the study. The study was done as a cross sectional study using a pretested standardized questionnaire. Age, sex, demographic data, height, weight, diet habits, family history of diabetes, exercise, medication in all the health care physicians were recorded and studied.</p><p class="abstract"><strong>Results:</strong> Of the total one hundred health care physicians, there were 50 male and 50 female physicians. Among the female physicians, there were 17 of age 41 to 50 years. There were 27 male and 34 female physicians with body mass index of 25 to 29.9. Six males and four females had diabetes mellitus. Six physicians were doing regular exercise. Four physicians were taking both oral anti hyperglycemic drugs and insulin.</p><p class="abstract"><strong>Conclusions:</strong> Doctors are aware and educated part of the society but there is high prevalence of obesity and diabetes mellitus among healthcare physicians. Doctor have to be motivated to take care of their health and to prevent lifestyle disease complication. Further regular screening for diabetes and obesity has to be done for doctors. <strong></strong></p>2019-05-24T07:02:46-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1603Evaluation of serum gamma-glutamyl transferase and highly sensitive C-reactive protein as biomarkers of oxidative stress and inflammation in type 2 diabetes mellitus patients with good and poor glycemic control2019-05-24T07:02:47-06:00Vishwanath Krishnamurthyvishu_ani@yahoo.comArun Sangappa Pattedarun.medico135@gmail.comAnil Kumar T.buddhatozen@yahoo.co.inSujatha Kuppuswamy Jayaramsuji_ivy@yahoo.comBhavana Shree Magajibhavanamagaji.feb@gmail.com<p class="abstract"><strong>Background:</strong> Diabetes mellitus comprises a group of common metabolic disorders which share common phenotype of hyperglycaemia. Oxidative stress and inflammation are associated with poor glycaemic control and further pathogenesis and complications of diabetes mellitus. This study investigated for correlation of good and poor glycaemic control with these factors.</p><p class="abstract"><strong>Methods: </strong>Subjects selected for the study were divide into three groups, group I control (n=35), group II type 2 diabetes mellitus patients with good glycaemic control (n=35) and group III type 2 diabetes mellitus patients with poor glycaemic control (n=35). Patients complete blood count, random blood sugar, HbA1c, HsCRP and GGT were investigated. These parameters were statistically analysed for correlation between HbA1c with GGT and HbA1c with hsCRP.</p><p class="abstract"><strong>Results:</strong> The mean HbA1c in group I, II and III were found to be 5.17%, 6.54% and 9.23% respectively. It was statistically significant (p=0.01), as according to the criteria defined for study recruitment. Furthermore, mean GGT and hsCRP levels were evaluated; a statistically significant difference in mean GGT levels as well as hsCRP of three different groups were obtained with a p value of 0.02. Correlation between HbA1c and hsCRP was found to positive (R2=0.17, p=0.03). When GGT was compared with HbA1c across the groups, there was a statistically significant correlation (R2= 0.09, p=0.03).</p><p class="abstract"><strong>Conclusions:</strong> Present study established a positive correlation between HbA1c and GGT, HbA1c and hsCRP, indicating increasing oxidative stress and inflammation in patients with poor glycaemic control. <strong></strong></p>2019-05-24T07:02:47-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1679Reno-protective effect of angiotensin converting enzyme inhibitor and angiotensin II receptor blockers in type 2 diabetic nephropathy with elevated urine albumin to creatinine ratio2019-05-24T07:02:47-06:00Ashok Vankayalaashokvankayala407@gmail.comKaruna Sagar Manthadrkarunasagar878@gmail.comPraveen Varma B. H. V. K.varma.bhvk@gmail.comSuresh Babu Sayanasuresh.pharmacology@gmail.comRaju D. S. S. K.dsskraju@gmail.com<p class="abstract"><strong>Background:</strong> Nephropathy is responsible for an End Stage Renal Disease (ESRD) in type 2 diabetics if uncontrolled. The monotherapy/combination of Angiotensin Converting Enzyme inhibitor (ACEi) and Angiotensin II Receptor Blockers (ARBs) can retard the progression of urine albumin to creatinine ratio in diabetic nephropathy but, the data shows an inconsistency in the efficacy of these drugs. So, the present study was aimed at comparing the reno-protective effect of ACEi/ARBs in type 2 diabetics.</p><p class="abstract"><strong>Methods: </strong>A prospective, randomized study is conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India with 100 patients, who are randomly categorised and equally distributed among the two groups and treated with Enalapril (ACEi) and Losartan (ARBs) for 6 months. 24-hour urine albumin to creatinine ratio and HbA1c are recorded before and after the treatment.</p><p class="abstract"><strong>Results:</strong> Enalapril and losartan showed a non-significant reduction in urine albumin to creatinine ratio from 196.2±17.5 to 185.9±15.2 (p=0.66) and 236.8±16.3 to 193.7±20.6 (p=0.11) respectively. A strict glycemic control has shown a reduction in HbA1c in both the groups.</p><p class="abstract"><strong>Conclusions:</strong> Present findings suggested that losartan is relatively more effective than enalapril in reducing the 24-hour urine albumin to creatinine ratio of diabetic nephropathy patients. Along with these drugs, regulation of blood glucose will assist in retarding the progression of nephropathy in type 2 diabetics.</p>2019-05-24T07:02:47-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1691Thiamine deficiency related peripheral neuropathy in peripartum women of Kashmir, India: a hospital based study2019-05-24T07:02:47-06:00Sheikh Hilal Ahmaddrhilal@gmail.comS. Bashir Ahmaddrhilal@gmail.comAsma Jandrhilal@gmail.com<p class="abstract"><strong>Background:</strong> Beri Beri is still seen in Asian countries due to the large-scale consumption of thiamine depleted polished rice. Thiamine deficiency related disorders are increasingly being reported from Kashmir from last two decades. Specifically, a sensorimotor axonal neuropathy occasionally develops from thiamine deficiency and may occur even without associated Wernicke’s encephalopathy.</p><p class="abstract"><strong>Methods: </strong>This study is a retrospective observational study. All peripartum females referred to our departments from January 2016 to December 2017 with complaints of generalized weakness and or sensory symptoms in form of paresthesias /numbness in limbs were enrolled. Clinical features, electrophysiological features, course in hospital and response to treatment in suspected thiamine deficiency related neuropathy patients were recorded.</p><p class="abstract"><strong>Results:</strong> Forty-three cases were included in the study. Twenty-nine patients were suspected to have nutritional neuropathy because of thiamine deficiency at the time of admission. Out of these 27 showed improvement on treatment with thiamine.</p><p class="abstract"><strong>Conclusions:</strong> Thiamine responsive neuropathy is common in peripartum women of this part of world. Diagnosis is usually made clinically, in at risk individuals presenting with characteristic clinical features. <strong></strong></p>2019-05-24T07:02:47-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1761Prevalence of endothelial dysfunction in acquired immune deficiency syndrome patients and its correlation with degree of immunodeficiency2019-05-24T07:02:47-06:00Zorinsangi Vartemarinivarte@gmail.comNaveen P.naveenphysiol@gmail.comWendy L. Raltewendyralte@yahoo.com<p class="abstract"><strong>Background:</strong> Number of factors play a role in endothelial dysfunction observed in AIDS patients, which can lead to atherosclerosis along with cardiovascular mortality and morbidity. Human immunodeficiency virus (HIV), the etiologic agent of AIDS causes several vascular disorders characterized by an evident activation and perturbation of endothelial cells. Currently, there is lack of data in the Indian literature regarding study of endothelial dysfunction in HIV patients. The purpose of our research was to study the prevalence of endothelial dysfunction in HIV/AIDS patients.</p><p class="abstract"><strong>Methods: </strong>The study comprises a total number of 60 adult HIV positive patients of both sex (male and female) with confirmed HIV seropositivity. The patients were divided into two groups of 30 each, depending on the degree of immune dysfunction (CD 4 cell counts). Group I- patients with CD 4+T cell count&gt;200/µl and group II-patients with CD 4+T cell count&lt;200/µl. These patients were subjected to detailed clinical examination and markers of endothelial dysfunction-flow mediated vasodilatation (FMD) of brachial artery, S. nitrite and C-reactive protein (CRP) were performed.</p><p class="abstract"><strong>Results:</strong> The defect in endothelial function was most prevalent in patients with more severe immunosuppression. FMD of brachial artery was decreased in patients with CD 4+T cell count &lt; 200/µl (7.07±2.89, p=0.00). S. nitrite was also significantly lower in group II patients (26.43±15.38), and these patients also showed more CRP positivity and higher CRP titres ranging from 1.2 mg/dl to 9.6 mg/dl.</p><p class="abstract"><strong>Conclusions:</strong> The defect in endothelial function was most prevalent in patients with more severe immunosuppression. FMD of brachial artery was decreased in patients with CD 4+T cell count &lt;200/µl (7.07±2.89, p=0.00). S. nitrite was also significantly lower in group II patients (26.43±15.38), and these patients also showed more CRP positivity and higher CRP titres ranging from 1.2 mg/dl to 9.6 mg/dl. <strong></strong></p>2019-05-24T07:02:47-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1687Total antioxidant status in type 2 diabetes mellitus with diabetic nephropathy2019-05-24T07:02:47-06:00Heena Singlaheenasingla76@yahoo.comGitanjali Goyalheenasingla76@yahoo.comCheenu Gargheenasingla76@yahoo.comKajal Bhallaheenasingla76@yahoo.com<p class="abstract"><strong>Background:</strong> Diabetes mellitus has emerged as one of the most common health hazard all over the world. Diabetic nephropathy is the most challenging long term complication of Type 2 Diabetes mellitus and microalbuminuria is the earliest marker of diabetic nephropathy. In diabetes, chronic hyperglycemia and deranged lipid profile lead to excess generation of free radicals. The increased oxidative stress plays a major role in pathogenesis of diabetic complications, including diabetic nephropathy. There are many naturally occurring antioxidant enzymes in our body. Diabetes has multiple effects on protein levels and activity of these antioxidant enzymes. This further augments the oxidative stress. There are many non-enzymatic antioxidants in our body which include vitamins A, C, E and trace minerals like copper, zinc, manganese and selenium.</p><p class="abstract"><strong>Methods: </strong>The study was done on a total of 150 subjects. Group A comprised of 60 Type 2 diabetic patients with diabetic nephropathy, Group B comprised of 60 Type 2 diabetic patients without diabetic nephropathy and Group C comprised 30 healthy controls. Total antioxidant status, microalbuminuria and glycosylated haemoglobin were measured.</p><p class="abstract"><strong>Results:</strong> In present study, authors found that total antioxidant status is drastically reduced in all diabetic patients, and it was found to be further low in patients with diabetic nephropathy. This decrease was found to be directly proportional to the degree of diabetic nephropathy, as measured by the levels of microalbuminuria.</p><p class="abstract"><strong>Conclusions:</strong> Timely institution of antioxidant supplementation therapy may emerge as a promising measure in delaying the onset and progression of diabetic complications, especially diabetic nephropathy. <strong></strong></p>2019-05-24T07:02:47-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1689Peripheral haematological manifestations in HIV infection and its relation to CD4 count2019-05-24T07:02:47-06:00Lalit Jainsearchpratap08@gmail.comAmit A. Singhsearchpratap08@gmail.comPratap S. Chauhansearchpratap08@gmail.com<p class="abstract"><strong>Background:</strong> HIV infection is associated with a wide range of haematological abnormalities, which are amongst its most common complications. This study aims at discerning the peripheral haematological abnormalities associated with HIV infection and to correlate them with CD<sub>4</sub> cell count.</p><p class="abstract"><strong>Methods: </strong>An observational cross-sectional study was conducted from March 2017 till August 2018. 109 patients in 15 years or more age group who were HIV positive by the NACO guidelines were included. Complete hemogram, serum iron studies, serum folate and vitamin B12 levels, and flowcytometric CD4 cell count analysis were done for all the patients. Various haematological parameters were compared between the patients with CD<sub>4</sub> cell counts &lt;200/µl (n=52) to those with counts &gt;200/µl (n=57). By using student t-test, the p-value was calculated for various parameters.</p><p class="abstract"><strong>Results:</strong> Anaemia (58.7%), leucopenia (27.5%) and thrombocytopenia (17.4%) were seen with anaemia being the most common abnormality. Normocytic normochromic anaemia (65.6%) was the predominant type of anaemia. Overall analysis showed a statistically significant difference between two groups in haemoglobin concentration, RBC indices, serum ferritin values and absolute lymphocyte count; with p-value &lt;0.05.</p><p><strong>Conclusions:</strong> The diagnosis and treatment of haematological disorders are essential in medical care of the HIV-infected patients. Thus, in resource limited setups, where CD<sub>4</sub> count analysis is not possible, haematological abnormalities can be used as tools for monitoring HIV positive individuals and can aid in the treatment of the patients.</p>2019-05-24T07:02:47-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1478Study of highly sensitive C-reactive protein in type 2 diabetes mellitus and prediction of cardiovascular risk with glycemic status2019-05-24T07:02:48-06:00T. Doraickannudrsvv99@gmail.comT. Sechassayanadrsvv99@gmail.comS. Vithiavathidrsvv99@gmail.comMomin Varisalidaifuparthu@gmail.com<p class="abstract">Inflammation plays a vital role in accentuating the formation of atherosclerotic plaque in diabetes mellitus. So, the measurements of inflammatory markers provide a method of assessing cardiovascular risk. Among the inflammatory markers, highly sensitive C-reactive protein (hs-CRP) is used to detect the low-level inflammation when it is within the normal range. Also, hs-CRP measurement may be useful for assessment of the risk of complication in diabetes patients. So, the present study is conducted to measure plasma hs-CRP level in T2DM and to determine adequate glycaemic control reduces hs-CRP level. The objectives of this study were to correlate HbA1c and hs-CRP in T2DM and predict cardiovascular risk with glycaemic status.</p><p class="abstract"><strong>Methods: </strong>Authors took 50 diabetic patients. The investigation includes FBS, PPBS, hs-CRP and HbA1c. hs-CRP is measured by immunoturbidimetry method. The reports were collected and compared with normal reference range.</p><p class="abstract"><strong>Results:</strong> The correlation between hs-CRP levels and HbA1c level after six months show a significant relationship where mean HbA1c values on day 1 and after 6 months were 8.088±1.219 and 7.518±0.693 respectively. The hs-CRP values were 2.508±1.050 on day 1 and 2.15±0.927 after 6 months proving that better glycaemic controls decrease hs-CRP thereby decreasing cardiovascular risk.</p><p class="abstract"><strong>Conclusions:</strong> hs-CRP values are directly related to HbA1c and better glycaemic control reduces risk of CVD. <strong></strong></p>2019-05-24T07:02:48-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1696Compare and correlate the levels of lipoprotein (a) and high-sensitive C-reactive protein in coronary heart disease with control2019-05-24T07:02:48-06:00Kamal Lochan Beheralochank398@gmail.comAshok Vankayalaashokvankayala407@gmail.comSuresh Babu Sayanasuresh.pharmacology@gmail.comD. S. S. K. Rajudsskraju@gmail.com<p class="abstract"><strong>Background:</strong> The incidence of ischemic heart disease/ myocardial infarction is rapidly increasing in India. However, the traditional risk factors alone could not explain this excess of Coronary Heart Disease (CHD). So, we are in need of a tool to assess the severity and prognosis of these acute coronary syndromes. Lipoprotein (a) [Lp(a)] and High Sensitive C-Reactive Protein (hs-CRP) have been recognised as independent risk factors for CHD in many retrospective case control studies. As the data shows inconsistency in the prediction of risk by Lp(a) and hs-CRP, the study is carried out to compare and correlate the levels of Lp(a) and hs-CRP in coronary heart disease patients with controls.</p><p class="abstract"><strong>Methods: </strong>An observational case control study was conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, with 120 participants. 80 admitted with CHD were categorised as type 2 diabetic and non-diabetic. Remaining 40 participants were age matched controls, who have attended the OP for general health check-up. Samples collected from the participants were analysed for Lp(a), hs-CRP and HbA1c.</p><p class="abstract"><strong>Results:</strong> Lp(a) levels were significantly elevated in CHD patients with diabetes (69.2±27.5) and non-significant in CHD patients without diabetes (50.4±24.3) as compared to their controls (36.6±22.5). There was significant correlation and elevation of hs-CRP in CHD patients with diabetes (6.0±2.6) and without diabetes (3.7±2.0) as compared to their controls (0.7±0.4).</p><p class="abstract"><strong>Conclusions:</strong> The present study shows a lack of association of Lp(a) levels in CHD patients with and without diabetes. A strong correlation of the inflammatory marker, hs-CRP was observed between the CHD patients with and without diabetes and even as compared to their controls. It may be concluded that hs-CRP is a better and independent marker than Lp(a) in patients with CHD. <strong></strong></p>2019-05-24T07:02:48-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1699Electrocardiography changes in localizing the culprit vessel in acute myocardial infarction with angiographic correlations2019-05-24T07:02:48-06:00Senthil Kumar Sampathdrsenthil77@yahoo.comVithiavathi Sivasubramaniandrsvv99@gmail.comSatish Lakshminarayanandrsln6669@gmail.com<p class="abstract"><strong>Background:</strong> The electrocardiogram is the primary diagnostic tool to evaluate a patient with chest pain and suspected myocardial infarction. Anterior wall infarction due to occlusion of proximal LAD has worse prognosis compared to distal or branch vessel lesions. Diagnosis of anterior/inferior/posterior or lateral MI is based on patterns of ST deviation and risk assessment based on absolute magnitude of ST segment deviation or the width of QRS complexes. Although coronary angiography is the gold standard for determining the infarct related artery in acute myocardial infarction, ECG can be useful tool in identifying the culprit artery involved at the primary care.</p><p class="abstract"><strong>Methods: </strong>A prospective cross-sectional study was conducted in Aarupadai Veedu Medical College and Hospital. Standard 12 lead electrocardiograph were recorded for 50 patients at a speed of 25 mm/s and voltage of 10mm/mv. Patients who had acute inferior wall MI additional right pericardial leads were recorded (V3R and V4R). The recorded ECG was interpreted using the electrocardiographic algorithms of Zimet-baum PJ et al. An ST elevation or depression was considered significant only if it was &gt;1mm.</p><p class="abstract"><strong>Results:</strong> The study result showed maximum specificity for LCx (100%) followed by RCA (92.67) and LAD (89.91). The sensitivity for identifying the culprit artery by ECG in acute myocardial infarction was 100% for both LAD and RCA coronary artery but 0% for LCx coronary artery. In case of LAD occlusion, the sensitivity is 100% for proximal LAD occlusion and 92.86%for distal LAD occlusion. The sensitivity and specificity for proximal and distal RCA is 100% and 80.43% respectively.</p><p class="abstract"><strong>Conclusions:</strong> ECG is an easily, widely available and non-invasive tool to localize the site of culprit artery in acute myocardial infarction. <strong></strong></p>2019-05-24T07:02:48-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1700Improvement in radiographic quality workflow due to use of digital imaging and picture archiving and communication system2019-05-24T07:02:48-06:00Abdul Haseeb Wanisoberseeb@gmail.comArshed Hussain Parryarshedparry@gmail.comShakeel Ahmad Khandaywaneiroufei@gmail.comTariq Ahmad Gojwaritariqgojwari@gmail.com<p class="abstract"><strong>Background:</strong> PACS (Picture archiving and communication systems) and digital imaging (DI) has revolutionized radiology bringing about a paradigm shift in the way radiodiagnosis is perceived and practiced with a slew of benefits like elimination of the need for manual handling of films, helping in long term storage of digital images, easy transfer and retrieval of radiographic images. The objective of this study was to analyse the influence of PACS and digital imaging on the workflow in the radiology, performance of the radiographer and image storage and retrieval capabilities.</p><p class="abstract"><strong>Methods: </strong>It was a questionnaire-based study in which questions were asked to the radiographers working in our hospital at five different working sites. Each questionnaire was aimed to evaluate the effect of digital imaging on radiology workflow, improvement in the performance of radiographers, reduction in the work-related frustration levels due to use of digital imaging and finally the utility of digital imaging in image storage, query and retrieval.</p><p class="abstract"><strong>Results:</strong> Among the 50 questionnaires 41 were completed and retrieved. Among the respondents, 90.24% indicated that digital imaging has obviated the need for repeat examinations, 95.12% agreed with the fact that it resulted in the reduction of the number of reject images, 95.1% said it helped them in improving their performances, 92.6% of the respondents said they did not face any issue with its use and 95.1% of the participants agreed that the image query and retrieval could be accomplished in a hassle-free manner.</p><p class="abstract"><strong>Conclusions:</strong> The digital imaging technique not only improves the performance of the radiographers but also increases the workflow of the health care hospitals or clinics. The digital imaging reduces the number of rejected images thus reducing radiation exposure to the patients. Further, it is highly cost-effective and time-saving. <strong></strong></p>2019-05-24T07:02:48-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1701Effect of statins treatment on glycemic status and development of new onset diabetes mellitus in a tertiary care teaching hospital: a cross sectional study2019-05-24T07:02:48-06:00K. N. S. V. Chalapathi Raoknsvchalapathi@gmail.comAshok Vankayalaashokvankayala407@gmail.comSuresh Babu Sayanasuresh.pharmacology@gmail.comD. S. S. K. Rajudsskraju@gmail.com<p class="abstract"><strong>Background:</strong> Several observational studies, well controlled randomized trials and meta-analyses reported that patients treated with statins has high risk of new onset diabetes mellitus (NODM), but the exact incidence and mechanism is still unclear and controversy. The present study was planned to find out the incidence of prediabetes and NODM and possible mechanism of action.</p><p class="abstract"><strong>Methods: </strong>This was a prospective, cross‑sectional study carried out at the Department of General Medicine for a period of one and half year between August 2017 and February 2019. Normoglycemic patients whose fasting blood glucose levels below 100 mg/dL and at least one year of treatment with statins were recruited in the study. Glycaemic status, development of prediabetes and NODM and insulin resistance were the primary outcomes whereas lipid profile, adverse drug effects of statins were secondary outcomes. Collected data was analysed by suitable statistical methods.</p><p class="abstract"><strong>Results:</strong> A total of 146 patients were recruited and 120 completed the entire study. Mean fasting blood glucose levels before initiation of statin therapy was 89.45±10.21. After one year of statin therapy, patients were separated as prediabetics and new onset diabetics and there mean fasting blood glucose levels were 116.24±12.86 (n=10) and 152.44±20.12 (n=12) respectively. A total of 12 (10.0%) patients were developed NODM and 10 (8.2%) patients developed prediabetes at the end of statin therapy. Atorvastatin 40mg was most frequency prescribed statin followed by Atorvastatin 20mg. A total of 70 (58.3%) study participants developed mild to moderate drug related adverse effects (ADRs), statin‑induced myalgia (55.7%) was the most common ADR.</p><p><strong>Conclusions:</strong> Patients treatment with statins had developed prediabetes and NODM. Atorvastatin 40mg and greater dose significantly induced NODM. Fasting blood glucose levels should be measured periodically with prescription contains higher doses of statins.</p>2019-05-24T07:02:48-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1708A comparative study to ascertain the efficacy of intravenous dexmedetomidine versus intravenous tramadol to prevent post-operative shivering after laparoscopic surgery2019-05-24T07:02:49-06:00Kishore K.shanmugampt@rediffmail.comSyed Ali Aasimaasim.dr@rediffmail.comManish Kumar J.aasim.dr@rediffmail.com<p class="abstract"><strong>Background:</strong> Shivering is commonly encountered both after regional and general anaesthesia (GA) with a little higher incidence in patients receiving GA. The aim of study was to compare the effectiveness of dexmedetomidine and tramadol in decreasing postoperative shivering in patients undergoing laparoscopic surgery.</p><p class="abstract"><strong>Methods: </strong>Total 120 patients were included in this study. In order to get a 5% level of significance and 80% power number of patients required in each group was 40, with a total of 120 patients. Randomization of groups was done based on closed envelope method. Patients were allocated into three groups group I, II and III of 40 patients each. Patients in group I and group II were administered 0.75 μg/kg of dexmedetomidine and 1.5 mg /kg of tramadol in 100 ml NS respectively half a before extubation, while patients in group III did not receive any pharmacological intervention.</p><p class="abstract"><strong>Results:</strong> All three groups were comparable regarding distribution of age, gender, ASA grade and temperature at beginning and end of surgery and were non-significant.</p><p class="abstract"><strong>Conclusions:</strong> Dexmedetomidine seems to possess anti-shivering properties and was found to reduce the occurrence of shivering in patients undergoing general anaesthesia with minimal side effects although its anti-shivering effect was not superior to tramadol. <strong></strong></p>2019-05-24T07:02:49-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1716Microalbuminuria among obese and non-obese individuals: a case control study2019-05-24T07:02:49-06:00G. Karthikeyanmanithaila@rediffmail.comM. Natarajmanithaila@rediffmail.com<p class="abstract"><strong>Background:</strong> Microalbuminuria among obesity cases reflects specific glomerular damage or is the marker of generalized endothelial cell dysfunction is still debatable. Thus, this study aimed to assess the presence of microalbuminuria among obese persons and non-obese individuals, who were euglycemic and normotensive.</p><p class="abstract"><strong>Methods: </strong>A case control study was conducted among patients attending outpatient department of general medicine in Govt Thiruvarur Medical College, Thiruvarur, for their illnesses from June 2017 to December 2017. A total of hundred participants with fifty obese cases and fifty non obese controls were included in this study. Detailed history and examination were done by the principal investigator and the same was documented in a proforma. Data entry was done using Microsoft excel and the statistical analysis includes odds ratio were calculated using Statistical Package for Social Sciences (SPSS) software version 17.</p><p class="abstract"><strong>Results:</strong> Among the study participants, 32% and 4% had microalbuminuria in obese and non-obese group, respectively. Also, obese participants were 11.29 times at higher chances of having microalbuminuria when compared to the non-obese patients with significant p value (p=0.002).</p><p class="abstract"><strong>Conclusions:</strong> Microalbuminuria can be used to predict the risk of complications in obese subjects in order to bring down the overall morbidity and mortality related to renal function. <strong></strong></p>2019-05-24T07:02:49-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1717A comparative study of lipid profile in smokers and non smokers between 30 to 40 years and prediction of 10 years risk of cardiovascular disease based on Framingham scores2019-05-24T07:02:49-06:00Mithun M.drdanfi@yahoo.co.inDhandapani .dhandapani@gmail.comVenkatraman .venkatraman@gmail.comArun Daniel J.drdanfi@yahoo.co.in<p class="abstract"><strong>Background:</strong> Atherosclerosis has been described as a lipid driven inflammatory disorder of the arterial wall. Smoking is one of the most common modifiable risk factors for atherosclerosis and is the major epidemiological factor in increasing morbidity and mortality of chronic heart diseases (CHD). The objectives of this study were based on to estimate the status of lipid profile in both smokers and non-smokers and compare with each other, to predict the 10 years risk of cardiovascular risk based on Framingham score in smokers and non-smokers.</p><p class="abstract"><strong>Methods: </strong>This retrospective, case-control study was conducted among 50 smokers (cases) and 50 normal individuals (controls) attending to the department of medicine during the period between December 2016 and May 2018. The socio-demographic data and clinical history was obtained using a semi-structured questionnaire and then patients were subjected to blood investigations including estimation of lipid profile by CHOD/PAP method.</p><p class="abstract"><strong>Results:</strong> The mean age of the study participants was 34.7±2.9 years. The duration of smoking among the smokers was 5.4±2.9 years on an average. There was a significant increase in serum cholesterol levels (245.6±39.8 versus 155.8±15.2 mg/dl), serum triglycerides (217.3±42.2mg/dl versus 127.4±10.6), LDL (171.1±35.2 versus 85.7±15.1 mg/dl) and VLDL (43.5±10.5 versus 15.3±5.5mg/dl) among the smokers versus non-smokers. There was a significant (p&lt;0.001) decrease in HDL levels among the smokers (30.8±3.4 mg/dl) when compared with the non-smokers (44.8±5.3 mg/dl). There was a highly significant difference between Framingham risk scores of smokers and non-smokers.</p><p class="abstract"><strong>Conclusions:</strong> The study established that the lipid profile was deranged towards atherogenesis among the smokers when compared to the non-smokers which was reflected in the significant increase in risk as calculated by Framingham risk score. <strong></strong></p>2019-05-24T07:02:49-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1720Spectrum of imaging findings in trans-gastric migration of accidently ingested metallic foreign bodies2019-05-24T07:02:49-06:00Arshed Hussain Parryarshedparry@gmail.comMohammad Saleem Darsalimess47@gmail.comAbdul Haseeb Wanisoberseeb@gmail.comTariq Ahmad Gojwaritariqgojwari@gmail.comIrfan Robbanidrimzaferoz@gmail.com<p class="abstract"><strong>Background:</strong> An accidently ingested foreign body may get lodged within the lumen of gastrointestinal tract, pass uneventfully with feces or may migrate extraluminally into the surrounding tissues in which case it may lead to suppurative or vascular complications. The aim of the endeavor was to study the spectrum of imaging findings in patients with accidental ingestion of foreign bodies with trans-gastric migration of metallic foreign bodies.</p><p class="abstract"><strong>Methods: </strong>Total<strong> </strong>33 patients with history of accidental ingestion of foreign bodies were subjected to preliminary radiograph of neck, chest and abdomen followed by upper gastrointestinal endoscopy. Failure to retrieve/ localize foreign body endoscopically from upper gastrointestinal tract with check radiograph reiterating the presence of foreign body in upper abdomen were subjected to computed tomography of abdomen.</p><p class="abstract"><strong>Results:</strong> A total of 33 patients comprising of 27 females and 6 males with mean age of 23.76 years with history of foreign body ingestion were studied. Ingested foreign bodies were lodged in pharynx (n=7), esophagus (n=3), stomach (n=13) or duodenum (n=3). In 7 patients in whom endoscopy failed to locate and/or retrieve foreign body, computed tomography confirmed the presence of trans-gastrically migrated foreign body in the surrounding structures. The location of migrated foreign bodies was in lesser sac (n = 2), greater omentum (n = 3), lesser omentum (n = 1) and transmural (n = 1). Two patients had evidence of collection formation around the migrated foreign bodies.</p><strong>Conclusions:</strong> Sharp or pointed metallic foreign bodies may migrate trans-luminally with various implications. Though radiography is the preliminary workhorse for the confirmation of ingested foreign bodies, computed tomography owing to its volumetric data acquisition helps in exact localization of migrated foreign bodies and should precede any therapeutic intervention for retrieval of migrated foreign bodies.2019-05-24T07:02:49-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1731Pancytopenia: the perspective from Western Gujarat, India2019-05-24T07:02:50-06:00Shubhangi V. Deshpandeshubhangi311@yahoo.comVarsha Y. Godboledrvgodbole@gmail.comArchana D. Asherarchanaasher258@yahoo.co.in<p class="abstract"><strong>Background:</strong> Pancytopenia is one of the common laboratory findings in patients presenting to us with varied clinical presentations. Risks of untreated Pancytopenia are high causing anxiety to treating doctors and patients alike. It also involves long list of investigations including a very painful marrow biopsy, life-threatening complications and treatment involves multiple blood component therapy. A total of 101 cases of pancytopenia over a period of 1 year were analysed retrospectively to find i) commonest presenting symptoms ii) commonest cause of pancytopenia, response to treatment iii) Depending on the cause, to consider if any measures can be taken for prevention</p><p class="abstract"><strong>Methods: </strong>Cross sectional study of 101 admitted patients of Pancytopenia on the basis of information extracted from the case sheets. The data was analyzed and presented as frequencies and Percentages.</p><p class="abstract"><strong>Results:</strong> Out of 101 cases analysed, 53 (52.47%) were females 48 (47.52%) patients males. Fatigue 74 patients (73.2%) was the commonest presenting symptom followed by fever 33 (32.6%), breathlessness 13 (12.87%) and bleeding 4(3.8%). Vitamin B12 deficiency 58 (57.6%) patients showed and was the commonest cause of pancytopenia. Infections in 24 (23.7%) like malaria16 (15.6%), dengue 5 (4.96%), PLHA 1(0.96%) and hepatitis B 2 (1.96%) was the second common cause in present study. Recovery of pancytopenia was prompt in Malaria Dengue. HIV, Hepatitis B viral infection showed persistent pancytopenia with hypoplastic marrow. Chronic liver disease portal hypertension splenomegaly accounted for 9 (8.9%) patients. Drug induced marrow suppression due to ongoing treatment for underling disease resulted in pancytopenia in 4 (3.96%) patients. Aplastic anaemia in3 (2.9%), myelodysplastic syndrome 2 (1.9%) and acute leukaemia 1 (0.96%) were the less common causes.</p><p class="abstract"><strong>Conclusions:</strong> Commonest symptom on presentation were related more to anaemia than to neutropenia and thrombocytopenia. megaloblastic anaemia due to Vitamin B12 deficiency was the leading reversible cause of pancytopenia in present study followed by infections like Malaria Dengue. Gujarat, India being predominantly vegetarian state, local dietary habits are thought to be responsible for inadequate B12 daily consumption, hence we suggest fortifying the daily diet with B12 supplementation at a larger scale just like iodisation of salt to counter iodine deficiency. <strong></strong></p>2019-05-24T07:02:50-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1745Association of microvascular complications of type 2 diabetes mellitus with ABO blood group2019-05-24T07:02:50-06:00Geetika Guptadrgeetikamahajan@gmail.comBhavna Langerdr.bhavnalanger@yahoo.inTabinda ShahTabindashah2015@gmail.comAnil K. Guptadranilguptajmu@rediffmail.comMumtaz Gonidrmumtazgoni@gmail.com<p class="abstract"><strong>Background:</strong> Micro vascular complications are the major outcome of Type 2 Diabetes Mellitus progression, which reduces the quality of life and increases diabetic morbidity &amp; mortality. As the incidence of type 2 diabetes is growing day by day; our search for its aetiology and pathogenesis is also ever growing to predict its risk factors and early screening for better care and prevention of its complications. Many studies have tried to link susceptibility of type 2 diabetes with ABO blood group though results have been inconsistent. The present study aims to analyse association of micro vascular complication with different blood groups if any.</p><p class="abstract"><strong>Methods: </strong>A cross sectional study was conducted among patients of type 2 diabetes Mellitus in a tertiary care hospital. Determination of ABO and Rh status was done by standard slide method of agglutination. Detailed information about age, gender, BMI, duration of diabetes, age of onset of diabetes was noted with the help of a proforma. The records (clinical examination and investigations done by physician) were screened for type of micro vascular complications.</p><p class="abstract"><strong>Results:</strong> Out of a total of 319 patients suffering from type 2 diabetes, 209 subjects (65.15%) had one or the other complications. A statistically significant (p=0.00) difference was observed between the presence or absence of complications in different blood groups. In patients with Blood group B, 76.14% presented with complications. Though Nephropathy was the most common complication observed among different blood groups, none of the type of micro vascular complication was found to be significantly associated with different blood groups.</p><p class="abstract"><strong>Conclusions:</strong> The findings in our study suggest that although there was a significant association between presence or absence of complications and different blood groups, but this association was not significant for different types of complications. <strong></strong></p>2019-05-24T07:02:50-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1750Aetiology of new onset seizures in cases admitted to an intensive care unit of a tertiary care hospital: a two year study2019-05-24T07:02:50-06:00Ramesh Babu Pannemsujithbhanu1212@gmail.comVenkata Subrahmanyam Chinthasujatha2481@gmail.com<p class="abstract"><strong>Background:</strong> Seizures are a common neurological disorder encountered globally in regular medical practice. Hospital onset seizures may occur in patients who never had a history of seizure before hospitalization and may be due to causes that lead to hospitalization or acquired during hospitalization like stroke, neuro infection etc. The objectives of this study were the purpose of the present study was to study the incidence and to describe demographic and clinical characteristics of patients developing new onset seizures in an intensive care unit of a tertiary care hospital.</p><p class="abstract"><strong>Methods: </strong>A prospective study for two years was conducted on cases of seizures admitted in an intensive care unit of a tertiary care hospital. The etiology of all the cases was recorded based on the clinical history and necessary investigations like EEG and imaging studies of the brain in cases if required.</p><p class="abstract"><strong>Results:</strong> About 238 cases with males 177 and females 61 cases were enrolled, and 31-50 years was most common age group. Diabetes was the most common co morbidity associated and generalized seizures were most common. CVA was most common etiology (26.89%) and idiopathic next common. Infarct was most common cause of CVA and meningitis in infections. Generalized tonic clonic seizures was most common in cases with CVA as the aetiology followed by infective cases.</p><p class="abstract"><strong>Conclusions:</strong> It is mandatory to deal cautiously and carefully the cases of seizures developing in an ICU in addition to proper history and examination, each patient must undergo detailed EEG, imaging investigations and other ancillary investigations if necessary. <strong></strong></p>2019-05-24T07:02:50-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1756Effect of co morbidities on the clinical outcome of Dengue fever2019-05-24T07:02:50-06:00Dhivya P.drpdhivya11@gmail.comNagesh G. N.drnagesh10@gmail.comJayaramachandran S.chandru598@gmail.com<p class="abstract"><strong>Background:</strong> Dengue is the most rapidly spreading mosquito-borne viral disease in the world. A number of Dengue Haemorrhagic Fever (DHF) risk factors had been suggested. However, these risk factors may not be generalized to all populations and epidemics for screening and clinical management of patients at risk of developing DHF/ Dengue shock syndrome (DSS).</p><p class="abstract"><strong>Methods: </strong>A hospital based prospective case control study was done by taking 40 cases each of dengue fever with diabetes mellitus, hypertension, diabetes and hypertension and 30 cases of dengue with asthma/COPD and these patients were compared with controls of 100 patients with dengue fever but no comorbidities. All patients had Dengue serology NS1 or IgM positive.</p><p class="abstract"><strong>Results:</strong> Patients admitted with dengue fever with comorbidities had increased duration of hospitalization with P value of 0.012. The clinical outcome of the 250 patients. In the subgroup of dengue fever patients with DM and Dengue fever with DM and HTN, they were noted to have a 2.69 and 3.06 times increased risk effect of DHF.</p><p class="abstract"><strong>Conclusions:</strong> Dengue fever with DM or DM with HTN have a higher risk of developing DHF when compared with patients with dengue fever with no comorbidities. This finding helps us in triaging patients with comorbidities who develop dengue fever for specialized care and closer clinical monitoring. <strong></strong></p>2019-05-24T07:02:50-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1754Pre-operative and peri operative predictors of acute renal failure after cardiac surgery2019-05-24T07:02:50-06:00Praveen Dhaultadr.pdhaulta@gmail.comVikas Panwardr.vikaspanwar@gmail.com<p class="abstract"><strong>Background:</strong> Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.</p><p class="abstract"><strong>Methods: </strong>This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.</p><p class="abstract"><strong>Results:</strong> In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction &lt;35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction &gt;50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with &gt;2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with &gt;26%.</p><p class="abstract"><strong>Conclusions:</strong> The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF. <strong></strong></p>2019-05-24T07:02:50-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1775Study of electrolytes in patients of Dengue in a tertiary care hospital in India2019-05-24T07:02:50-06:00Prakash Ram Relwaniprakashrelwani@gmail.comNeelam N. Redkarnnredkar@yahoo.co.inDeepanshu Gargdgarg2311@gmail.com<p class="abstract"><strong>Background:</strong> Dengue is a mosquito borne viral infection. It is the most common arboviral disease globally. In the year 2017, India had 1,53,635 cases of dengue with 226 deaths. Electrolyte disturbances reported in dengue infection are hyponatremia, hypokalaemia and hyperchloremia. Considering the serious nature of effects of dyselectrolytemias and high incidence of dengue in India, it is necessary to have a thorough understanding about electrolyte disturbances in Dengue, so as to predict, diagnose and treat them accordingly.</p><p class="abstract"><strong>Methods: </strong>This study was performed in a tertiary care centre in Mumbai, India. The study was a prospective observational cross-sectional study. 150 Patients diagnosed with Dengue were enrolled for the study. Patients’ demographic data, clinical history, examination findings and investigations including electrolyte values were recorded and analysed.</p><p class="abstract"><strong>Results:</strong> A higher incidence of dengue was seen in young age group among admitted patients (74%). Hyponatremia (45.33%) and Hypokalaemia (10.60%) were more commonly observed than hypernatremia (3.33%) and hyperkalaemia (3.33%). Hypochloraemia (6.66%) was seen slightly more than hyperchloraemia (6.00%). Fever was Present in 98.66%, retro orbital headache in 86.66%, vomiting in 56.00%, joint pain in 69.00%, lethargy in 70.66%, breathlessness in 36.00%, bleeding in 8.66%, abdominal pain /tenderness in 18.00%. 85.00% had low platelet count, 30.66% had low hemoglobin and 36.66% had leucopenia. Haematocrit was found to be less in 27.33% and high in 1.33%.</p><p class="abstract"><strong>Conclusions:</strong> From the above results we concluded that, there is a need to have a degree of suspicion about dyselectrolytemias while managing patients with Dengue. Also, patients need to be subjected to necessary lab investigations early during management so that if abnormalities are found, they can be promptly and appropriately managed as some of these abnormalities may lead to increased severity as well as mortality.</p>2019-05-24T07:02:50-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1684Efficacy of pregabalin premedication prior to surgery in attenuating the adverse hemodynamic response to laryngoscopy and tracheal intubation2019-05-24T07:02:51-06:00M. Srinivas Reddydr_sreddy@hotmail.comNagaratna Murariratnadkm@gmail.com<p class="abstract"><strong>Background:</strong> In general pregabalin is used in patients with normal blood pressure undergoing operation for controlling the response of the pressor in nature. There are few studies which have been carried out to study efficacy of pregabalin in controlling responses to instrumentation of the airway in patients with controlled hypertension. Objective was to study efficacy of pregabalin premedication 90min prior to surgery in attenuating the adverse hemodynamic response to laryngoscopy and tracheal intubation.</p><p class="abstract"><strong>Methods: </strong>Hospital based randomized comparative trial was conducted. 100 patients of ASA I and II physical status aged 18-60 yrs scheduled to undergo elective surgery like orthopaedic, spine, otorhinolaryngeal, gynaecological and general surgical procedures. Patients were randomly divided into 2 groups of 50 each. Randomization was done by computer generated table. Group "P" received- 150mg pregabalin. Group "C" received-200µg clonidine.</p><p class="abstract"><strong>Results:</strong> The patients in clonidine group documented the heart rate as more compared to the patients in the pregabalin group at various time intervals. The patients in clonidine group documented the mean systolic blood pressure as more compared to the patients in the pregabalin group at various time intervals. The patients in clonidine group documented the mean diastolic blood pressure as more compared to the patients in the pregabalin group at various time intervals.</p><p class="abstract"><strong>Conclusions:</strong> We concluded that use of pregabalin is more effective in comparison to use of clonidine in terms of controlling the hemodynamic parameters. But it has been found that bradycardia may not be properly attenuated with the use of pregabalin. <strong></strong></p>2019-05-24T07:02:51-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1541A study to assess valvular heart disease in a tertiary care hospital: a single centre finding2019-05-24T07:15:08-06:00Prakash R. Ghogaleprakash19782@gmail.comShishir K. Wanjaridrshishirwanjari@gmail.comDaneshwar Singhdrdaneshwar@gmail.comHanumanth N.hanu2statistician@gmail.comHarshal G. Mendhedrharshalmendhe@gmail.com<p class="abstract"><strong>Background:</strong> Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with an enormous burden on healthcare resources. The present study was undertaken to study incidence and demography of valvular heart disease, to assess echocardiography and colour doppler findings of patients with valvular heart disease and to find out complications in patients with valvular heart disease.</p><p class="abstract"><strong>Methods: </strong>A<strong> </strong>hospital based longitudinal case study was undertaken at medicine department of Dr. V.M. Government Medical College, Solapur, Maharashtra, India for a period of two years. One hundred and twenty-four (124) patients attending OPD participated in the study.</p><p class="abstract"><strong>Results:</strong> In the present study, out of 124 patients, mitral valve was most commonly involved, 105(84.67%) and the least common involved was tricuspid 1(0.81%). The most common aetiology was rheumatic origin 75(94.94%). In the present study the most common complication was pulmonary hypertension 69(55.65%), followed by congestive cardiac failure (33.87%), acute pulmonary edema (12.09%), infective endocarditis (4.84%), cerebrovascular accident (4.03%), left atrial thrombus (3.23%) and death (3.23%).</p><p class="abstract"><strong>Conclusions:</strong> Multiple valves were affected in more than a third of all cases, although recent research in India continue to demonstrate a declining trend in the prevalence of RHD, rheumatic involvement is still the dominant form of valvular heart disease in India.</p>2019-05-24T07:02:51-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1544Relationship between self-rated health status and physical activity in obese South Indian patients2019-05-24T07:02:51-06:00Virgin Joenadrjoena12@gmail.comAnanda Xavier Pragasamjoenaxavier@gmail.com<p class="abstract"><strong>Background:</strong> Regular physical activity can improve people's overall health and reduce various risks for morbidity and mortality due to a sedentary lifestyle. Although the evidence linking obesity with many chronic diseases is well established, the relationship with self-rated health is not clear. The study aimed to assess the relationship between physical activity and self-rated health and how it is related to obesity.</p><p class="abstract"><strong>Methods: </strong>The cross-sectional study included 132 individuals above18 years, of both genders, with BMI above 25kg/m<sup>2</sup>. Data was collected using a structured proforma which included apart from demographic parameters, anthropometry parameters, self-reported physical activity, health status and stress levels of the subjects. Chi-square test/Fisher's exact test was used to assess the association between BMI, physical activity and self-rated health.</p><p class="abstract"><strong>Results:</strong> A total of 132 subjects were included with a mean age of 48.44±11.23 years, with an almost equal proportion of males and females. The mean of BMI was 29.54±3.99. Most of them reported having normal physical activity (61.36%) with only 3% of them having high physical activity. The self-rated health of the subjects revealed 45.45% of them is having fair health and 43.18% of them having poor health. The mean a number of hours spent by sitting/sedentary activity in a week were 32.32±21.09.</p><p class="abstract"><strong>Conclusions:</strong> The study findings revealed that the irrespective of the degree of physical activity both overweight and obese subjects rated their health fair to poor. <strong></strong></p>2019-05-24T07:02:51-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1574Study on the prevalence of dyslipidemia in type 2 diabetes mellitus2019-05-24T07:02:51-06:00Eda Dayakardrsathyasree.physio@gmail.comC. Sathya Sreedrsathyasree.physio@gmail.comE. Sanjaydrsathyasree.physio@gmail.com<p class="abstract"><strong>Background:</strong> Diabetes mellitus is a common health problem globally. Dyslipidaemia is a major risk factor to develop cardiovascular disease in diabetics. They present study was undertaken to find out the prevalence of dyslipidaemia in type 2 diabetic patients.</p><p class="abstract"><strong>Methods: </strong>The present study was a cross sectional study consisting of 46 (23 male and 23 female) known type 2 diabetes mellitus patients. Age, gender, duration of diabetes, body mass index (BMI) was recorder in all the diabetic patients. Fasting blood glucose levels, total cholesterol, triglycerides, HDL, LDL, VLDL levels were measured using standard methods and recorded.</p><p class="abstract"><strong>Results:</strong> The average total cholesterol, triglycerides, LDL, HDL and VLDL were 200±42mg/dl, 169.62±89.79mg/dl, 132.45±36.38mg/dl,39.1±16.6mg/dl and 35.85±17.09mg/dl respectively. The incidence of occurrence of hypercholesterolemia was 58.6% and hypertriglyceridemia 36.9%. Increased levels of LDL were observed in 30 (65.2%) patients and reduced HDL was observed in 43 (93.4%) patients. The incidence rate of dyslipidaemia was higher in female diabetic patients when compared to male diabetic patients.</p><strong>Conclusions:</strong> Awareness on the dyslipidaemia and its risk factors should be provided to the type 2 diabetic patients as they are more prone to get cardiovascular disease and lipid profile also should be monitored regularly along with blood glucose levels.2019-05-24T07:02:51-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1578Effect of addition of intrathecal midazolam to 0.5% hyperbaric bupivacaine to prolong the post-operative analgesia in lower abdominal surgeries2019-05-24T07:02:51-06:00S. K. Adil Hasanhanu2statistician@gmail.com<p class="abstract"><strong>Background:</strong> Bupivacaine when used alone produces analgesia for 2.5 to 3 hours, making it unsuitable in cases where the duration of surgery is longer and in cases which require further analgesia during post-operative period. Present study is intended to evaluate the effect of addition of intrathecal midazolam to bupivacaine to prolong the post-operative analgesia.</p><p class="abstract"><strong>Methods: </strong>Present clinical study was conducted in Kamineni Institute of Medical Sciences, Narketpally, Nalgonda District, Andhra Pradesh, India. After obtaining approval from institutional ethical committee, present clinical study was undertaken to evaluate the effects of addition of intrathecal midazolam to bupivacaine 0.5% (heavy). The study was conducted on 60 patients undergoing lower abdominal surgeries.</p><p class="abstract"><strong>Results:</strong> Mean onset of analgesia was 190.5 with SD 21.3 in group-C whereas in group-M, mean onset of analgesia was 185.3 with SD 26.81. Mean difference between the groups not showing statistical significance. In the present study the Maximum height of sensory blockade in control and midazolam group was T7 (T6-T8) compared to T7 (T6-T8) midazolam group. Mean duration of sensory blockade was 130.4 with SD 36.36 in group-C whereas in group-M, mean duration of sensory blockade was 191.9 with SD 36.4. Mean difference between the groups showing statistical significance. Mean duration of motor blockade was 176.3 with SD 23.7 in group-C whereas in group-M, mean duration of motor blockade was 208.1 with SD 18.21. Mean difference between the groups showing statistical significance.</p><p><strong>Conclusions:</strong> Midazolam is a useful adjuvant to bupivacaine in subarachnoid block. Intrathecal midazolam combined with intrathecal bupivacaine produces a longer and more effective anaesthesia and analgesia. It also prolongs post-operative analgesia without increasing adverse effects. </p>2019-05-24T07:02:51-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1582Role of HbA1c with mortality and severity among the patients of Acute coronary syndrome: a prospective study2019-05-24T07:02:52-06:00Satish Chandelambrishmscology@gmail.comShishirendu Pariharshishirendu.parihar@gmail.comBharat Gramaniambrishmscology@gmail.comT. N. Dubeyambrishmscology@gmail.com<p class="abstract"><strong>Background:</strong> Blockage of coronary artery lead to a reduction of blood flow towards heart resulting in Coronary Artery Disease (CAD). CAD leads to myocardial complications. CAD is one of the important causes of death all over the world including India. Diabetes mellitus is a risk factor for CAD. Reports have also shown to increase in cardiovascular morbidity among patients with glucose intolerance. In present study we tried to find the relationship of HbA1c levels with mortality, morbidity, and severity in Acute Coronary Syndrome (ACS).</p><p class="abstract"><strong>Methods: </strong>Two hundred patients with ACS were studied from 2018 to 2019 at Gandhi Medical College and Hamidia Hospital, Bhopal. Following a thorough medical history routine medical examination including laboratory investigations was performed in all the patients. Electrocardiography (ECG), creatine phosphokinase-muscle/brain (CPK-MB), echocardiography and coronary angiography (CAG) was also done as part of this study.</p><p class="abstract"><strong>Results:</strong> Mean age of the study cohort was 59.17±8.75 years. Out of 200 subjects, 110 (55%) were non-diabetic, 52 (26%) were diabetic, 38 (19%) had weakened glucose tolerance and 82 (41%) had hypertension. Left ventricular dysfunction (LVD) and heart failure (HF) were the common complications and were more prevalent among diabetic patients than the nondiabetics (p=0.009). HbA1c level (7.01±2.23) was high among subjects with complications than the subjects without complications (6.01±1.36).</p><p class="abstract"><strong>Conclusions:</strong> The patients with DM have higher morbidity and mortality than the non-diabetic patients of ACS and therefore such patients should be screened for diabetes and glucose intolerance for better management of CAD. <strong></strong></p>2019-05-24T07:02:52-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1588Fatigue and diabetes mellitus: a prospective study2019-05-24T07:02:52-06:00Parminder Kaurguliani1989@gmail.comS. N. Chughdrsnchugh@gmail.comHarpreet Singhdrhps1@rediffmail.comVikram S. Tanwardrvikrampgi@gmail.comGagandeep Sukhijagagan43@gmail.comRekha Mathurdrrekhamathur04@gmail.com<p class="abstract"><strong>Background:</strong> Fatigue is a common complaint among patients with diabetes mellitus (DM) that can undermine the daily functional activities of a person. The objectives of the study were to assess the fatigue in patients of newly diagnosed type 2 DM and to relate fatigue with blood glucose parameters (BGP) and glycemic control.</p><p class="abstract"><strong>Methods: </strong>A total 50 patients of type 2 DM, diagnosed as per American Diabetes Association 2011 criteria, were enrolled in the study group. Each subject was evaluated two times for fatigue using Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) scale. 1<sup>st</sup> assessment was at the time of enrollment and 2<sup>nd</sup> was done after achieving target control of type 2 DM. Values of Fasting blood glucose (FBG), postprandial blood glucose (PPBG), blood glucose variability (BGV) and glycosylated hemoglobin (HbA1c) were obtained for each subject at each assessment. Data collected was analyzed statistically.</p><p class="abstract"><strong>Results:</strong> Mean age of study group was 50.7±8.9 years with male to female ratio of 1.17:1. Mean values of MFSI-SF score at 1st and 2nd assessment were 14.10±17.97 and 4.64±14.06, respectively indicating a statistically significant improvement in fatigue (p&lt;0.05) after achieving target control. Overall fatigue, general fatigue, emotional fatigue, and vigor score correlated significantly with glycemic control (HbA1c) with correlation coefficient (r) of 0.337, 0.351, 0 .339, and - 0.281, respectively (all p &lt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> Fatigue had a positive correlation with FBG, PPBG and BGV and HbA1c. A significant improvement in all the parameters of fatigue was noted after control of diabetic status.</p>2019-05-24T07:02:52-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1590Evaluation of the lipid parameters in chronic heart failure patients and their correlation with body mass index2019-05-24T07:02:52-06:00Rohit Sanedrrohitsane@gmail.comGurudatta Amindrguruamin@gmail.comSnehal Dongredrsnehaldongre@gmail.comRahul Mandoledrrahulmandole@gmail.com<p class="abstract"><strong>Background:</strong> Increased body mass index (BMI) is associated with dyslipidemia, but relevant data in patients with cardiac morbidity is scarce. This study assessed lipid parameters in chronic heart failure (CHF) patients and their statistical correlation with BMI.</p><p class="abstract"><strong>Methods: </strong>The retrospective study utilized data of CHF patients who visited Madhavbaug clinics in India between July-December 2018. Serum lipid profile noted were total cholesterol (TC), triglycerides (TG), low-density lipoproteins (LDL), high-density lipoproteins (HDL) and very low-density lipoproteins (VLDL). Patients were classified based on BMI (normal, overweight, obese) and their mean lipid parameters were compared.</p><p class="abstract"><strong>Results:</strong> Out of 147 patients, 74.15% were males with mean age 59.15±10.28 years and mean BMI 26.69±4.97 kg/m2. 56 patients had normal BMI, 60 were overweight and 30 were obese. Mean TC, TG and LDL levels in the normal-BMI group were significantly lower than that in overweight and obese groups (p&lt;0.05). Mean HDL and VLDL were found to be higher in overweight group as compared to that in normal-BMI and obese group (p&lt;0.05). Weak positive correlations were found between BMI and TC (R=0.09, p&gt;0.05), BMI and TG (R=0.07, p&gt;0.05), BMI and LDL (R=0.09, p&gt;0.05) as well as BMI and VLDL (R=0.02, p&gt;0.05). There was inverse correlation seen between BMI and HDL (R=-0.12, p&gt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> Increase in BMI was associated with dyslipidemia in CHF patients. There was positive correlation of BMI with LDL, TG, TC as well as VLDL while there was negative correlation between BMI and HDL levels. Obesity may increase the dyslipidemia risk in CHF patients which may affect their prognosis. <strong></strong></p>2019-05-24T07:02:52-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1596Clinical and biochemical profile of patients hospitalized with jaundice: Experience from a teaching hospital in north India2019-05-24T07:02:52-06:00Suneel Chauhanchau.suneel@gmail.comBaldev S. Ranaranabsingh@yahoo.co.inRajesh Sharmahimanshunews@yahoo.comVijay K. Barwalbarwalvk@gmail.comNikhil Sooddrnikhil26@gmail.comNaveen Rananaveen.15singhrana@gmail.comShailender Minhasshailendraminhas@gmail.comAnkit Chaudharychaudarysaab13@gmail.com<p class="abstract"><strong>Background:</strong> Jaundice is a common problem in both medical and surgical practice. For best line of management, it is very essential to differentiate all types of jaundice. The cause can often be correctly anticipated clinically but usually biochemical and radiological imaging investigations are required for confirmation. Here we present a study on clinical and biochemical profile of jaundice patients admitted in a tertiary care hospital.</p><p class="abstract"><strong>Methods: </strong>It was an observational study and all patients admitted with jaundice in the department of medicine meeting inclusion/exclusion criteria were enrolled. Data was collected on a self-designed, pretested and structured format.</p><p class="abstract"><strong>Results:</strong> Out of 100 patients, 77 were males, and median age of 47.5 years. Apart from jaundice, anorexia was the most common presenting complaint (90%), while ascites was the most common finding. Cirrhosis (60%) was the most common cause of jaundice. The mean total bilirubin was 7.9 mg%. Mean Hemoglobin in patients with cirrhosis was 9.7gm/dL. 78% patients of cirrhosis revealed esophageal varices. Majority (80%) showed hypoproteinemia. PT was prolonged &gt;3sec in 87% of cases. On USG shrunken liver was noted in all patients with cirrhosis, enlarged liver was found in two patients of liver abscess while altered echotexture was seen in 66% cases. 90 patients improved, 9 died and only one was referred.</p><p class="abstract"><strong>Conclusions:</strong> Alcoholic liver disease was the leading cause of cirrhosis (92%). Jaundice in general and alcoholic cirrhosis in particular affects mostly the productive age group of the male population and has a high economic burden on our society. <strong></strong></p>2019-05-24T07:02:52-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1614A study of the influence of lipid profile in diabetic patients on the incidence of cerebrovascular events2019-05-24T07:02:52-06:00Taha Mahboob Ali Khalidtahamak@gmail.comRahul Gandhi G.drrahulgandhigoud@gmail.com<p class="abstract"><strong>Background:</strong> The relationship between elevated serum lipids and atherosclerosis is well established. Recent studies have demonstrated not only that the serum lipid concentration but also the distribution of TG and cholesterol within major lipoprotein classes are of importance for the development of atherosclerosis. Elevated plasma concentrations of LDL and decreased HDL are associated with increased risk of atherosclerosis. To study the influence of lipid profile in diabetic patients on the incidence of cerebrovascular events.</p><p class="abstract"><strong>Methods: </strong>The study was based on 60 patients meeting the inclusion criteria from those who were admitted at Shadan Institute of Medical Sciences, Hyderabad, India from Feb 2013-May 2014. Detailed history was taken and thorough physical examination done pertaining to the involved condition. Patients who were conscious, slow progression of neurological deficit, rapid onset of lateralizing signs with variable blood pressure were considered to be suffering from infarction.</p><p class="abstract"><strong>Results:</strong> The mean values of lipid profile were significantly different among the gender. There were more females with medium and high TC values as compared to females and this difference was found to be significant. Though the number of females with high HDL values was more than males, the difference was not found to be significant. The number of females with high LDL values was far more than males and this difference was found to be significant. Though the number of females was more with high TG values, the difference was not found to be significant.</p><strong>Conclusions:</strong> In conclusion, our study gives evidence that poor glycemic control is a strong risk factor for stroke in patients with NIDDM.2019-05-24T07:02:52-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1615Assessment of seven year long results of kidney biopsy2019-05-24T07:02:52-06:00Nambakam Tanuja Subramanyamtanujagirish6@gmail.comGirish P. Vakranidrvakranis@gmail.com<p class="abstract"><strong>Background:</strong> Kidney biopsy is a standard kidney biopsy tissue analysis to look at histopathological diagnosis of various kidney diseases. Previous studies have shown kidney biopsy findings mostly in pediatric population, and there is no much data on impact of various sized biopsy guns on biopsy outcome. This study includes all age group and describes impact of usage of various sized biopsy guns on biopsy outcome.</p><p class="abstract"><strong>Methods: </strong>A retrospective study was done on all patients who underwent kidney biopsy over 7 years.</p><p class="abstract"><strong>Results:</strong> Among total number of 386 patients, 55.2% were males. The commonest indication for biopsy was nephrotic syndrome. The commonest histopathological pattern was Lupus nephritis. Renal failure (RF) was found in 157 (40.7%) of which it improved in 78 (20.2%). Amongst RF patients, the commonest was IgA nephropathy. Change of needle size from 18G to 16G showed increased morbidity in the form of complications but also increased diagnostic yield. Biopsy related complications were noted in 0.8%-1.8%.</p><p class="abstract"><strong>Conclusions:</strong> The commonest indication for kidney biopsy was nephrotic syndrome. The commonest histopathological pattern was Lupus nephritis. Amongst RF patients, the commonest entity was IgA nephropathy. Change of needle size from thinner to thicker showed increased complications but also increased diagnostic yield too. <strong></strong></p>2019-05-24T07:02:52-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1617Significance of serum electrolyte imbalance and comparison between different testing methods in patients with altered sensorium presenting to tertiary care hospital2019-05-24T07:02:53-06:00Harjit S. Dumradrdumra@yahoo.co.inKautuk A. Patelkautuk1409@gmail.comGopal Ravalraval_g@yahoo.comMansi Dandnaikmansidandnaik@gmail.comAmrish Pateldrarpatel79@yahoo.co.in<p class="abstract"><strong>Background:</strong> Electrolyte disorders are common in patients in the emergency department and intensive care unit, and have been associated with increased morbidity and mortality. In this respect sodium and potassium are the most important cations, whose improper adjustment may cause severe neuromuscular disorders. This study was designed to compare values obtained by laboratory and point-of-care testing and also to find most frequent electrolyte abnormalities.</p><p class="abstract"><strong>Methods: </strong>Observational Study was done on 51 patients presenting to Tertiary care Hospital emergency department with altered sensorium between 1st January 2016 to 31st May 2017 fulfilling the inclusion criteria and willing for participation by giving written informed consent. Electrolytes were tested in patients with GCS 14 or less by both point of care system and in the laboratory.</p><p class="abstract"><strong>Results:</strong> The distribution of mean sodium and potassium levels did not differ significantly between two techniques (P-value&gt;0.05). The sodium and potassium levels by POC and laboratory techniques are significantly and positively correlated (P-value&lt;0.001). The distribution of mean along with 95% CI of mean of amount of bias in the estimation of Sodium and Potassium levels by POC against Laboratory method is 3.50 [2.79-4.20] mEq/L and 0.83 [0.55-1.11] mEq/L respectively. The most common electrolyte abnormality was hyponatremia.</p><p class="abstract"><strong>Conclusions:</strong> We concluded that it is advisable to do a point-of-care electrolyte in Emergency department and Intensive care unit. By use of point-of-care testing, we can identify electrolytes imbalance early in emergency department. Point-of-care electrolyte levels had a near comparable value with laboratory electrolyte levels.</p>2019-05-24T07:02:53-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1618Evaluation of efficacy of intravenous magnesium sulphate versus dexamethasone for prevention of postoperative sore throat in patients undergoing lumbar spine surgery in prone position: a prospective randomized double blind placebo controlled study2019-05-24T07:02:53-06:00Shahnaz Ahmad Sheikhumatbashir1@gmail.comAabid Hussain Mirmeeraabid111@gmail.comAbida Yousufdrabidayousuf786@gmail.comImtiaz Ahmad Naqashinaqash@rediffmail.com<p class="abstract"><strong>Background:</strong> Endotracheal intubation is associated with postoperative sore throat. The aim was to evaluate the efficacy of intravenous magnesium sulphate versus dexamethasone for prevention of postoperative sore throat in patients undergoing lumbar surgery in prone position.</p><p class="abstract"><strong>Methods: </strong>150 patients of ASA physical status I and II in the age group of 18 to 70 years were divided into three groups of 50 each. group I (magnesium sulphate) received intravenous magnesium sulphate 30 mg. kg-1 in a total of 50 ml of normal saline for 10 minutes after intubation, group II (dexamethasone group) received intravenous dexamethasone 8 mg in 50 mL normal saline for 10 minutes after intubation and group III (placebo group) received 50 ml of normal saline for 10 minutes after intubation. The incidence and severity of postoperative sore throat and hoarseness was assessed by an anesthesiologist unaware of the group allocation, on arrival in the post anesthesia care unit at 0 h, and at 1 h, 6 h, 12 h, and 24 h thereafter.</p><p class="abstract"><strong>Results:</strong> Both incidence and severity of sore throat and incidence of hoarseness was more in placebo group than magnesium sulphate group and dexamethasone group and was statistically significant (p&lt;0.05) and was comparable between magnesium sulphate and dexamethasone groups.</p><p><strong>Conclusions:</strong> Endotracheal intubation is associated with sore throat and hoarseness of voice. Magnesium sulphate and dexamethasone given intravenously reduce the incidence and severity of sore throat and hoarseness associated with endotracheal intubation.</p>2019-05-24T07:02:53-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1619Role of educational intervention with practical demonstration in improving inhaler technique2019-05-24T07:02:53-06:00Bharat Bhushaniamjebin@gmail.comKulbir Singhiamjebin@gmail.comJebin Abrahamiamjebin@gmail.comDeepak Goyaliamjebin@gmail.comArjun Bhatnageriamjebin@gmail.comJain Thomas Chungathiamjebin@gmail.comHeena Bhartiiamjebin@gmail.comKaran Sharmaiamjebin@gmail.com<p class="abstract"><strong>Background:</strong> Chronic respiratory diseases are among the leading causes of morbidity and mortality worldwide with chronic obstructive pulmonary disease (COPD) and asthma being the most common. There is under-utilization of the basic tools of inhalation therapy technique(s) in their management. Implementation of a personalized educational and demonstrational intervention by the attending physician during regular follow-up visits of these patients will substantially improve the treatment outcome.</p><p class="abstract"><strong>Methods: </strong>This prospective interventional study was conducted on 239 diagnosed cases of asthma and COPD. Inhaler technique was assessed in accordance to standard checklist and errors were corrected by a practical demonstration. A follow-up assessment was conducted for the same after 2 weeks. Data thus collected was evaluated.</p><p class="abstract"><strong>Results:</strong> Out of 239 patients, 47.6% (n=114) reported for follow-up assessment. Average reporting time for follow-up assessment was 27.4 days. Amongst them, an improvement of at least one step was found in 86.8% (n= 99) and about 28% (n=32) patients performed all steps correctly. Average number of steps improved was 2.1.</p><p class="abstract"><strong>Conclusions:</strong> Majority of the patients showed an improvement in the inhaler technique during follow-up assessment after an educational intervention and practical demonstration. Near perfection was achieved by about more than quarter of the patients. Regular practical demonstration of the inhalation technique during subsequent follow-up sessions unequivocally improves results.<strong></strong></p>2019-05-24T07:02:53-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1625Spectrum of opportunistic infections in relation to CD4 counts in HIV/AIDS patients admitted in the department of general medicine of a tertiary care hospital2019-05-24T07:02:53-06:00Deepak Pandharpurkarkrishnagudikandula@gmail.comNagender Devulapallykrishnagudikandula@gmail.comB. Gouthamikrishnagudikandula@gmail.comGudikandula Krishnakrishnagudikandula@gmail.com<p class="abstract"><strong>Background:</strong> HIV/AIDS was first recognized in USA in 1981 when centre for disease control (CDC) reported unexplained occurrence of Pneumocystis carinii pneumonia in 5 healthy homosexuals. Soon it was recognized in drug abusers and blood transfusion recipients. The present study has been taken up with an aim to know the incidence of various opportunistic infections in HIV positive patients and to correlate different opportunistic infections (OIs) with the CD4+cellcount.</p><p class="abstract"><strong>Methods: </strong>Sample of 132 cases admitted in Gandhi hospital during the study period were taken. CD4+ counting of blood samples was done by Flow cytometry as per manufacturer’s instructions (FACS Calibur, Becton- Dickinson, Immunocytometry system). Correlation of CD4 cell counts was done with the respective opportunistic infections.</p><p class="abstract"><strong>Results:</strong> TB (50%) is the most frequent OI followed by candidiasis (49%), pneumocystis (16%) and others. The mean CD4 cell count in TB was 110.80/mL and in candidiasis 97.84/mL. Low values were observed in CMV (27/mL) and in toxoplasmosis (61.66/mL).</p><strong>Conclusions:</strong> In most of the patient’s respiratory system was the most common system involved by OIs and had CD4 T cell count below 200/mL. Early diagnosis and prompt treatment of opportunistic infections is important. This study helps the clinicians in proper guidance to come up before development of severe immunodeficiency to prevent serious and fatal outcome.2019-05-24T07:02:53-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1637Vitamin B12 deficiency in patients with type 2 diabetes2019-05-24T07:02:54-06:00Tarun Sekhridrarashmi@yahoo.co.inRashmi Aggarwaldrarashmi@yahoo.co.inPradeep Chughdrarashmi@yahoo.co.inShreeshail Belagavidrarashmi@yahoo.co.inHemant Aggarwaldrarashmi@yahoo.co.in<p class="abstract"><strong>Background:</strong> Vitamin B12 deficiency may occur consequent to long-term treatment with metformin but very few studies in India have assessed this risk. Metformin is considered the drug of first choice not only for the management of type 2 diabetes but also for prediabetes and polycystic ovary disease. The aims and objective of study was carried out to assess the serum levels of vitamin B12 in Indian patients with type 2 diabetes mellitus who were treated with metformin for a minimum duration of five years.</p><p class="abstract"><strong>Methods: </strong>Serum vitamin B12 level was estimated in 39 patients with type 2 diabetes mellitus, who were on metformin for more than five years. vitamin B12 deficiency was defined as serum concentration less than 200 pg/dl. apart from vitamin B12, fasting blood sugar, post prandial sugar and glycosylated hemoglobin were also estimated.</p><p class="abstract"><strong>Results:</strong> 39 subjects in age group of 40-65 years, suffering from type 2 diabetes mellitus, for more than five years were recruited for the study. The mean serum level of vitamin B12 was 153.27±46.01. Vitamin B12 deficiency was found in 35.89%subjects.</p><strong>Conclusions:</strong> Patients suffering from long standing type 2 diabetes mellitus and taking large doses of metformin should be screened for Vitamin B 12 deficiency.2019-05-24T07:02:54-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1648Association of high-density lipoprotein and myocardial infarction: a cross sectional study2019-05-24T07:02:54-06:00Siraveni Thirupathidrthiruyadav@gmail.comChinnaiyan P.drchinnaiyan@yahoo.comSujeetha Chandrababudrsirisanthu123@gmail.com<p class="abstract"><strong>Background:</strong> There is substantial evidence illustrating a negative relationship between High Density Lipoprotein Cholesterol (HDL-C) to Coronary Artery Disease (CAD) progression. HDL concept can be put forward as a new concept in the field of cardiovascular research. The objective of this study was to carry out to observe the status of serum HDL-C level in Coronary Artery Disease patients and the impact of the level in them.</p><p class="abstract"><strong>Methods: </strong>It was a hospital based cross sectional observational study among 60 patients of acute myocardial infarction (MI) who were admitted in Medical intensive care unit. High density lipoprotein cholesterol (HDL-C) was determined using standard methods.</p><p class="abstract"><strong>Results:</strong> The study showed that 52 (86.7%) of study subjects had abnormal HDL-C level and 39 (65%) of subjects had abnormal CRP level. There is a negative correlation between HDL and other biochemical variables like LDL, LDL/HDL and CRP, i.e. as HDL decreases all the variables increase which is statistically significant. Majority of patients 52 (86.7%) with MI had abnormal HDL-C level which was not statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> Numerous studies showing evidence that high levels of HDL-Cholesterol associated with a lower risk of Coronary heart disease. This study showed that there is a low HDL-C level among coronary artery disease patient. The relationship between HDL and CAD proved to be an inverse one which caters the need to concentrate further on HDL. <strong></strong></p>2019-05-24T07:02:54-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1666Height is a risk factor for development of peripheral insensate neuropathy2019-05-24T07:02:54-06:00Sujjay J.srgreen@mgmcri.ac.inSiva Ranganathan Greensrgreen@mgmcri.ac.inMohamed Kasim A.srgreen@mgmcri.ac.in<p class="abstract"><strong>Background:</strong> Peripheral insensate neuropathy is one of the most common and forms of peripheral neuropathy. It is a preeminent cause for disability, foot ulcers, deformity and amputations in individuals who are at risk.</p><p class="abstract"><strong>Methods: </strong>A study was conducted in Mahatma Gandhi Medical College &amp; Research Institute, Pondicherry, India in the year 2017-18, which included examination of 760 people of more than 30 years of age by random sampling method who was attending the outpatient clinic. The Semmes Weinstein monofilament was adopted to ascertain the presence of peripheral insensate neuropathy.</p><p class="abstract"><strong>Results:</strong> In present study, the prevalence of peripheral insensate neuropathy was 3.2%. As the height increased, the prevalence of peripheral insensate neuropathy increased, regardless of other independent risk factors like diabetes, hypertension, etc. The risk of the peripheral insensate neuropathy increases at a height of &gt;171.5cm in males and at a height of &gt;164.5cm in females.</p><p class="abstract"><strong>Conclusions:</strong> The authors confirm that body height is a significant and independent risk factor for peripheral insensate neuropathy, regardless of co-morbidities. Height as a guide, helps the health care professionals in identifying the people who are at risk for peripheral insensate neuropathy. <strong></strong></p>2019-05-24T07:02:54-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1675Thyroid hormones, blood glucose and glycosylated hemoglobin in healthy Sudanese subjects2019-05-24T07:05:40-06:00Abdelmuhsin H. EisaMuhsineisa1184@gmail.comAmir A. Bashiramirali69@yahoo.comAsim A. Osmanasim9517@gmail.comIbrahim A. Alihemamedicine@gmail.comKamal M. Awadkamalmhmd@hotmail.comElnagi Y. Hajonagihago@yahoo.comElmutaz H. Tahaelmutaz.taha735@gmail.comAbeadalla A. Alboraiborai81@hotmail.comOmer A. Musaomusa56@yahoo.co.uk<p class="abstract"><strong>Background:</strong> Diabetes mellitus and thyroid diseases are the most prevalent metabolic disorders in Sudan. The value of HbA1C reflects the glycemic status over the last 2-3 months. So, in this study, an insight for thyroid hormone regulation of glucose metabolism is investigated. Is to study the association between thyroid hormones levels, fasting blood sugar (FBS) and HbA1c in healthy adults.</p><p class="abstract"><strong>Methods: </strong>A cross sectional study was performed in a healthy Sudanese cohort in the period between September 2017 to November 2018, involving 610 healthy adult Sudanese aged 20 to 60 years. HbA1c, fasting blood sugar (FBS), T3, T4 and TSH were measured.</p><p class="abstract"><strong>Results:</strong> The study results demonstrated a significant association between the median concentration of T3 and T4 with plasma level of HbA1c. A significant linear correlation between serum concentration of T3 and fasting blood sugar (FBS) was observed. Inverse correlation was detected between serum TSH and HbA1c, FBS in study population.</p><p class="abstract"><strong>Conclusions:</strong> The present study concluded that FBS and HbA1c levels were increased with increasing of both T3 and T4. Based on this study all the thyroid patients’ especially hyperthyroid patients should have regular checkup of their glucose levels.<strong></strong></p>2019-05-24T07:02:54-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1685Ephedrine versus phenylephrine: effects on fetal acid-base status during spinal anesthesia for elective cesarean delivery2019-05-24T07:02:54-06:00Pradeep KumariPradeep.choudhary042@gmail.comSifna TahirSifna.tahir@gmail.comAltaf Ahmad Mirdrmeeraltaf@gmail.comHaveena Kumarihaveenarana14@gmail.com<p class="abstract"><strong>Background:</strong> During elective caesarean sections, post-spinal hypotension is a common problem. Prevention of this complication by sympathomimetic agents is of potential clinical significance. The objective of this study was to compare and evaluate the effects of ephedrine and phenylephrine on the fetal outcome when used in the treatment of maternal hypotension during spinal block in elective caesarean section.</p><p class="abstract"><strong>Methods: </strong>After fulfilling the inclusion criteria, hundred patients were enrolled in this study and were randomly allocated into two groups of fifty each. According to their group, patients received either ephedrine 6 mg (group E) or phenylephrine 75µg (group P) as vasopressor. For spinal anaesthesia lumber puncture was done in sitting position and 12.5mg, 0.5% hyperbaric bupivacaine was given intra-thecally to every patient. Throughout surgery, maternal and neonatal complications were controlled and recorded. During the study, Apgar scores on the 1<sup>st </sup>and 5<sup>th</sup> minutes, and blood gases of the umbilical cord blood were evaluated.</p><p class="abstract"><strong>Results:</strong> Ephedrine and phenylephrine were used in the mean doses of 6.72±1.97mg and 91.5±31.38µg respectively. There was no significant difference observed in total number of boluses used in treating post-spinal hypotension. The difference in the first- and fifth-minute Apgar scores was statistically insignificant between the group E and group P. There was a statistically significant difference observed in SaO<sub>2</sub> and base excess in arterial gas sample between two studied groups. Similarly, a significant difference was observed in PCO<sub>2</sub> of umbilical venous sample between two studied groups. However, none of the neonates had the true fetal acidosis.</p><p class="abstract"><strong>Conclusions:</strong> Intravenous phenylephrine 75µg and ephedrine 6 mg offer a comparable hypotensive control without any significant complication for mother or her fetus in elective caesarean section. <strong></strong></p>2019-05-24T07:02:54-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1694Using modified tutorless problem-based learning approach with ‘SET triggers’ to teach diabetes mellitus to undergraduate medical students2019-05-24T07:02:54-06:00Karan Shrikant Patilfamcoquiz1111@rediffmail.comDinesh Chandra Guptafamcoquiz1111@rediffmail.comSwapnil Ganeshpurefamcoquiz1111@rediffmail.com<p class="abstract"><strong>Background:</strong> The purpose of this study was to introduce modified form of conventional problem-based learning (PBL) i.e. “Tutor less PBL” in educating medical students about type 2 diabetes mellitus (T2DM). Medical students are future physicians and can be effective healthcare professionals to screen and manage diabetes at community level. Poor levels of awareness as well as lacunae in teaching diabetes have been reported among medical students. The study aimed to assess the knowledge of undergraduate medical students about T2DM by using “Tutorless PBL” method.</p><p class="abstract"><strong>Methods: </strong>Sixty-two 8<sup>th</sup> semester medical students from one of the private medical colleges in Mumbai city attained knowledge about T2DM through “Tutorless PBL” and “conventional PBL”. “A structured set of engagements triggers” (SET) was used in Tutorless PBL. Students responded through pre and post-test questionnaires and ‘student’s unpaired t test’ compared their test scores. Fourteen item questionnaires with Likert scale evaluated students’ feedback about both methods.</p><p class="abstract"><strong>Results:</strong> The post test scores were more for students in “Tutor less group” than in “tutored group” (15.37 vs. 14.01). The difference was statistically significant (t=5.87, p&lt;0.001). All (100%) students appreciated both methods for enhancing their knowledge about T2DM. “Tutor less PBL” was found to be more effective than “conventional PBL” in promoting self-learning and critical thinking abilities.</p><p class="abstract"><strong>Conclusions:</strong> Both methods were beneficial to students in terms of clarifying the topic, improving group interaction and yielding self-directed learning. Tutorless problem-based learning can be an effective option especially in resource (faculty) limited setting. <strong></strong></p>2019-05-24T07:02:54-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1695Knowledge attitude and practice towards human papilloma virus vaccination among medical and paramedical students in a tertiary care teaching hospital in south Karnataka, India2019-05-24T07:02:55-06:00Shruthi B.linkinsri@gmail.comSrikanth Goud Mallamlinkinsri@gmail.comManojkumar B. K.linkinsri@gmail.comDhanalakshmi T. A.linkinsri@gmail.com<p class="abstract"><strong>Background:</strong> Human papilloma virus infection is responsible for 75-80% of the cervical cancers worldwide. Human papilloma virus infection is a preventable disease, but precaution depends on the cognitive aspects of young women. Authors conducted a study to assess the knowledge, attitude and practices regarding human papilloma virus vaccination and to determine acceptance rate of human papilloma virus vaccination among medical and paramedical students.</p><p class="abstract"><strong>Methods: </strong>Human papilloma virus infection is responsible for 75-80% of the cervical cancers worldwide. Human papilloma virus infection is a preventable disease, but precaution depends on the cognitive aspects of young women. Authors conducted a study to assess the knowledge, attitude and practices regarding human papilloma virus vaccination and to determine acceptance rate of human papilloma virus vaccination among medical and paramedical students.</p><p class="abstract"><strong>Results:</strong> Out of 322 students, 114 medicals (35.4%), 106 pharmacy (32.9%) and 102 nursing students (31.7%) were included in this study. Ninety-one (79.8%) medical students, 64 (60.37%) pharmacy students, 43 (42.1%) nursing students were aware that human papilloma virus can cause cervical cancer. Seventy-three (64.03%) medical students, 64(60.37%) pharmacy students, 40(40.1%) nursing students were aware that there is vaccination for human papilloma virus infection, and it can prevent cervical cancer. Most of the students,78(68.4%) medical students, 57 (53.77%) pharmacy students and 46(45.09%) nursing students believe that more awareness required regarding risk factors of human papilloma virus infection and prevention of cervical cancer. Furthermore, around 66 (57.89%) medical students, 44 (41.05%) pharmacy students, 37(36.27%) nursing students were willing to accept the vaccine for themselves.</p><p class="abstract"><strong>Conclusions:</strong> Majority of the students are lacking knowledge regarding HPV vaccination and cervical cancer prevention with least knowledge among paramedical students. More awareness programmes are required to increase the awareness and acceptability of HPV vaccination. <strong></strong></p>2019-05-24T07:02:55-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1703Spectrum of prostate gland lesions: a clinico-pathologic study in south-western Bihar, India2019-05-24T07:02:55-06:00Rajendra Kumarneerurkumar@rediffmail.comWakeel Ahmadneerurkumar@rediffmail.com<p class="abstract"><strong>Background:</strong> Prostate gland is an endocrine dependent organ in males and age-related lesions involve it. Inflammation, benign nodular hyperplasia and tumours are the commonest to involve it worldwide. Occasionally some other pathological changes can also involve it. The study was carried out for the first time to know the spectrum and prevalence of prostate lesions which will be of help to the clinicians in this location.</p><p class="abstract"><strong>Methods: </strong>Retrospective study was carried out for a period of four years and out of surgical cases of males which underwent operative procedure, prostate cases were retrieved and in the department of pathology, haematoxylin and eosin stained slides were evaluated and diagnosed.</p><p class="abstract"><strong>Results:</strong> A total of 138 cases were included and five cases were excluded from this series. Benign nodular hyperplasia (73.9%) was the commonest finding followed by chronic prostatitis associated with hyperplasia (15.2%), atypical glandular hyperplasia (2.9%) and prostatic intraepithelial neoplasia (2.1%). Malignant tumours were 5.8% constituting adenocarcinoma prostate as the most common (62.5%). A case of hemangiopericytoma was also diagnosed.</p><p class="abstract"><strong>Conclusions:</strong> Benign nodular hyperplasia of prostate is the most common affliction among males starting at age 45 years. Early consultation and screening will be of immense value. Adenocarcinoma prostate may involve at age around 58 years. <strong></strong></p>2019-05-24T07:02:55-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1705A study on diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function2019-05-24T07:02:55-06:00M. Ilamarandr.n.saranya@gmail.comA. Thangadhuraidr.n.saranya@gmail.comP. Suresh Kumardr.n.saranya@gmail.comSaranya Nagalingamdr.n.saranya@gmail.com<p class="abstract"><strong>Background:</strong> Diastolic heart failure, otherwise called as heart failure with preserved ejection fraction, is common finding of hypertensive heart disease, but various studies report a high incidence of diastolic heart failure in patients with type 2 diabetes mellitus in spite of the absence of coronary artery heart disease and hypertension. The objectives of the study were to determine the prevalence of dysfunction of left ventricle in diastole in type 2 diabetes mellitus patients and to compare with the non-diabetic individuals with that of asymptomatic type II diabetes patients. To assess the correlation of diastolic dysfunction in diabetes with age of patients, HbA1c levels, duration of diabetes, retinopathy, autonomic neuropathy.</p><p class="abstract"><strong>Methods: </strong>A prospective cross sectional among them 50 patients were diabetics and 50 were non-diabetic controls. Diastolic dysfunction was measured with standard echocardiographic parameters and the results were computed with corresponding variables of the patients. All the variables and their data were analysed for percentage, mean, standard deviation ‘t’ test and chi square test. The ‘t’-test was used to study the quantitative data while chi square test was used to study the qualitative data.</p><p class="abstract"><strong>Results:</strong> Among the study population 60% had diastolic dysfunction and 14% had diastolic dysfunction among cases and control group respectively. Diastolic dysfunction was present among 23.3% and the 76.7% of the age group groups of less than 45 and more than 45 years of age respectively. In this study poor glycaemic status was significantly associated with diastolic dysfunction, whereas duration of diabetes, retinopathy and autonomic neuropathy were not statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> Present study reveals moderately high incidence of diastolic dysfunction in asymptomatic diabetic; subjects and, this finding was correlated with the HBA1C levels but not with retinopathy and autonomic neuropathy. <strong></strong></p>2019-05-24T07:02:55-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1711Antihypertension medication adherence and associated factors at tertiary care hospital, Gujarat, India2019-05-24T07:02:55-06:00Dinkar Goswamidngo081067@gmai.com<p class="abstract"><strong>Background:</strong> According to world health organization (WHO) describes poor adherence as the identical cause of uncontrolled blood pressure and estimates that 50-70% of people do not take their antihypertensive medication as prescribed. The objectives of this study were to investigate the adherence and persistence of antihypertensive drugs in Indian rural population as well as monitoring adverse drug reactions and its relation to compliance.</p><p class="abstract"><strong>Methods: </strong>This cross-sectional study conducted among 300 hypertensive patients taking treatment at tertiary care hospital in Gujarat, India. Structured questionnaires consisting of open and closed ended questions on the antihypertensive drug adherence were distributed to patients for those found on the study area at time of data collection and the left-over pills of individual patient were counted to strengthen the consistency of the research.</p><p class="abstract"><strong>Results:</strong> Prevalence of non-adherence found in 24.3% participants. Present study found statistically significant association between socio-demographic factors (age, religion, marital status, occupation, substance abuse, education and family history of HT) with treatment adherence of hypertension among study participants. The other factor associated to non-adherence was therapy factor 32.9% (P=0.001) from the total non-adherence, in this case patients were supposed to unwanted effect of the drug and they were not able to take the medication.</p><p class="abstract"><strong>Conclusions:</strong> The main possible reasons for non-adherence were ‘refuse to take regular treatment’,‘cost of treatment’, ‘poor patient-doctor relation’, ‘unwanted side effect of drugs’ and other factors like age, marital status, occupation, education level, family H/O, substance abuse and religion are also playing supporting role to develop non-adherence to treatment. <strong></strong></p>2019-05-24T07:02:55-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1719Practices for diabetes mellitus in doctors2019-05-24T07:02:55-06:00Vasanti A. Jeergalvjeergal@rediffmail.comJayshree J. Upadhyejayshreeupadhye@gmail.com<p class="abstract"><strong>Background:</strong> Doctors know everything about cause, diagnosis, treatment and care to be taken for diabetes mellitus. This study was carried out to evaluate awareness, attitude and practices of diabetes in doctors.</p><p class="abstract"><strong>Methods: </strong>A cross sectional study was conducted among 100 male and 100 female doctors of various subjects who attended a conference at Mangaluru 25<sup>th</sup> to 27<sup>th</sup> October 2018.</p><p class="abstract"><strong>Results:</strong> Prevalence of diabetes mellitus was 12% in male doctors while it was 8% in female doctors. 11 (91.66%) male doctors and 8 (100%) female doctors were taking medicines for diabetes regularly, 8 (66.66%) male doctors and 7 (87.5%) female doctors were doing blood sugar regularly, 7 (58.33%) male doctors and 5 (62.5%) female doctors were doing diet control, 7 (58.33%) male doctors and 5 (62.5%) female doctors were doing exercise regularly, 9 (75%) male doctors and 8 (100%) female doctors were using footwear while 6 (50%) male doctors and 4 (50%) female doctors were taking proper dental care.</p><p class="abstract"><strong>Conclusions:</strong> In present study, doctors were aware of causes, diagnosis, treatment &amp; care to be taken in diabetes. Still, routine check-up was not seen in 100%. After diagnosis, doctors were taking medicines quite regularly but regular follow up for diabetes &amp; cardiovascular risk was seen in less numbers.<strong></strong></p>2019-05-24T07:02:55-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1722Mortality profile of confirmed cases of swine flu attending a tertiary care center of Udaipur region of Rajasthan, India2019-05-24T07:02:55-06:00Yogesh Kumar Singhalyogya_iam@yahoo.co.inNitin Kotharinknitinkothari@gmail.com<p class="abstract"><strong>Background:</strong> Mortality profile is an analytical tool used to identify the various factors responsible for poor outcome of disease and it can also use to evaluate quality and efficiency of healthcare providers. The aim of this study is to summarise the clinical and epidemiological factors as well as to identify the risk factors associated with mortality among swine flu cases.</p><p class="abstract"><strong>Methods: </strong>It is a cross-sectional, descriptive, hospital-based study conducted on 62 deceased patients due to swine flu reported at Maharana Bhupal Government Hospital, Udaipur, Rajasthan during the outbreak of influenza A H1N1 in the year 2015. A standardized pre-structured questionnaire with consent was filled by help of bed head tickets and by interview of attendants of deceased patients.</p><p class="abstract"><strong>Results:</strong> Deaths were higher among age group of 31-45 years (35.48%). Case fatality rate for male patients (13.88%) was higher. Mortality was highest in females of rural background 27(43.55%). Majority of deceased patients (70.97%) had delay of 4-7 days in admission after onset of symptoms. Diabetes, cardiovascular diseases and pregnancy was the major risk factors for poor outcome.</p><p class="abstract"><strong>Conclusions:</strong> Delay in diagnosis and admission may be the reason for higher mortality rate. The most common co morbid illness was Diabetes mellitus, cardiovascular diseases (Ischemic heart disease, Rheumatic heart disease, Hypertension) and pregnancy. <strong></strong></p>2019-05-24T07:02:55-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1663A clinical and microbiological profile of urinary tract infection in patients with chronic kidney diseases2019-05-24T07:02:56-06:00Siddharth Pugalendhisiddhartharjun07@gmail.comTarun Kumar Duttatkduttajipmer@yahoo.co.ukHemachandar R.tkduttajipmer@yahoo.co.ukLokesh S.tkduttajipmer@yahoo.co.uk<p class="abstract"><strong>Background:</strong> Urinary tract infections (UTIs) are a major public health problem in terms of morbidity and financial cost in CKD patients in India. The resistance pattern of community acquired uropathogens in CKD patients has not been extensively studied. Thus, knowledge of local antimicrobial susceptibility patterns of common uropathogens is essential for prudent empiric therapy of community acquired UTIs.</p><p class="abstract"><strong>Methods: </strong>It is a cross sectional study conducted in a tertiary care hospital involving 65 chronic kidney disease patients with UTI who attended general medicine OPD and those admitted in wards after fulfilling the inclusion and exclusion criteria, after obtaining written informed consent. Blood sample and urine samples were collected from these patients and sent for blood analysis, urine analysis and urine culture and sensitivity.</p><p class="abstract"><strong>Results:</strong> Among 65 CKD participants with UTI who were studied, <em>E. coli</em> (47.7%) and <em>K. pneumoniae</em> (15.4%) were the most common isolates which were sensitive in order of colistin, polymyxin B, meropenem (carbapenem) and less sensitive to other commonly used antibiotics.</p><p class="abstract"><strong>Conclusions:</strong> The main purpose of this study was to find the various common local uropathogens in CKD patients and their antibiotic profile which will help in formulating antibiotic therapies. As previously stated, there are very few studies regarding profile and management of UTI in CKD patients. Hence this study can throw some light into this area. <strong></strong></p>2019-05-24T07:02:56-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1713Importance of spirometry, pulse oximetry and hematocrit in chronic obstructive pulmonary disease2019-05-24T07:02:56-06:00Vinay Kumar A.sonureddy67@gmail.comSai Smarat K.sonureddy67@gmail.comSony Reddysonureddy67@gmail.com<p class="abstract"><strong>Background:</strong> To study the correlation of clinical features, spirometry, pulse oximetry assessment and haematocrit abnormalities in chronic obstructive pulmonary disease and to assess the severity of chronic obstructive pulmonary disease by spirometry.</p><p class="abstract"><strong>Methods: </strong>In the present study total 50 cases were selected on the basis of simple random sampling method from the Department of Pulmonary Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Bommakal, Karimnagar, Telangana, India. During study period from June 2017 to December 2018.</p><p class="abstract"><strong>Results:</strong> About 50 patients of chronic obstructive pulmonary disease were studied. Majority of the patients were in the age group of 50-70 years. COPD was seen predominantly in male patients and majorities were smoker. In the majority of patients, the duration of illness was 6-10 years, cough with expectoration was present in all patients. As the number of cigarettes/day and duration increases the severity of the disease also increases in the studied population. In the study, about 40 % of cases were in stage III disease. Computerised spirometry was found to be most sensitive investigation in diagnosing and assessing the severity of the disease in all these cases. As the severity and duration of the disease increases, they are more prone to develop hypoxia and polycythaemia as a complication. In present study 8 patients had hypoxia, as assessed by pulse oximeter.</p><p class="abstract"><strong>Conclusions:</strong> Computerized spirometry is a very useful investigation in the management of chronic obstructive pulmonary disease. Pulse oximetry is a useful tool in diagnosing periods of oxygen desaturation. Pulse oximetry also useful in monitoring the oxygen therapy during management. Haematocrit analysis is a useful adjunct in assessing the severity of the disease. Polycythaemia, even though uncommon in chronic obstructive pulmonary disease patients is one of the rare but preventable complication with early cessation of smoking and with oxygen therapy. <strong></strong></p>2019-05-24T07:02:56-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1517A prevalence study of vaginal candidiasis among pregnant women2019-05-24T07:02:56-06:00Pooja Sutariapsutaria29@gmail.comMeera Cholerameer17578@yahoo.comShilpa B. Dongadrshilpadonga@yahoo.com<p class="abstract"><strong>Background:</strong> Pregnancy is associated with specific anatomical, physiological and immunological changes that can predispose to infection and also alter the response to the disease process. Infections in pregnancy demands prompt adequate and careful management. The disease process as well as the treatment protocol may have profound effects on the outcome of pregnancy. Pregnant women frequently develop vaginal discharge which can lead to complications during pregnancy like abortions, premature birth, low birth weight and other morbidities. Some of the infections may be serious and life threatening for the mother while others may seriously jeopardize the fetus or neonate leaving the mother asymptomatic. The aim and objective of this study was based on the present study was aimed to study the prevalence of vaginal candidiasis among pregnant patients who were visited in outdoor patient’s department of Prasutitantra and Streeroga.</p><p class="abstract"><strong>Methods: </strong>About 135 high vaginal swabs were collected from the women who carrying 2<sup>nd </sup>and 3<sup>rd</sup> trimester of pregnancy with symptoms of vaginal infection. These samples were tested under microscopic examination and culture on Mac Conkey agar, blood agar and Sabouraud dextrose agar respectively. Colonial morphology, wet/K.O.H. preparation, gram staining, germ tube test, were carried out for identification of the isolated organisms.</p><p class="abstract"><strong>Results:</strong> Out of 135 samples collected, 61 (45.18%) patients were shown positive fungal infection of candidial species. The age group showing the highest number of positive candidiasis was of 20 to 25 years. Multigravida (60%) were more commonly affected than primigravida (40%) and commonly seen in third trimester (67.41%).</p><p class="abstract"><strong>Conclusions:</strong> Vaginal Candidiasis was common in pregnant women with more common in young adults. <strong></strong></p>2019-05-24T07:02:56-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1693A study on outcome of rodenticide poisoning patients admitted to a tertiary care teaching hospital in relation to the chemical content of that poison2019-05-24T07:02:56-06:00Lokesh N. K.lahari2k253@gmail.comShivakumar K. M.lahari2k253@gmail.comYamunaraj S. D.lahari2k253@gmail.com<p class="abstract"><strong>Background:</strong> Poisoning is the major health problem in India. Rodenticides are the commonest poisoning in Asian countries like India. Rodenticides are the substance used to kill rats. Prognosis mainly depends on chemical content of poison.</p><p class="abstract"><strong>Methods: </strong>This retrospective record-based study was conducted between January 2017 to December 2017 at government hospital department of general medicine, MIMS, Mandya, Bangalore, Karnataka, India. Data regarding age, sex, marital status, occupation, type of poison, route of exposure, and outcome of poisoning and associated co-morbid conditions were collected from the hospital records and documented in the pre-structured proforma. Descriptive analysis was carried out by the mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.</p><p class="abstract"><strong>Results:</strong> Out of 56 patients 33 (59%) were female 23 (41%) were male. Most common age group was 20 to 30 years, followed by 31 to 40 years group. Most common poison was yellow phosphorous (41%), followed by aluminium phosphide (29%). Most common complication was hepatitis (20%),followed by cardiogenic shock (9%).Total mortality was 3 (5%).</p><p class="abstract"><strong>Conclusions:</strong> Among rodenticides yellow phosphorous was most common consumed poison in present study. Aluminium phosphorus was most lethal poison. Even though there is no specific antidote, early symptomatic treatment is the key in reducing the mortality. <strong></strong></p>2019-05-24T07:02:56-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1697Comparison of model for end-stage liver disease-Na score and model for end-stage liver disease score in predicting in-hospital mortality in patients with end stage liver disease: an observational study2019-05-24T07:02:56-06:00Tirthankar Mukherjeedoctor.tirthankar@gmail.comKamalesh Tagadur Natarajutnkamalesh@gmail.comB. M. Rakeshbmrakesh123@gmail.comSoumya Dattanagowda Dandothisoumyadd14@gmail.com<p class="abstract"><strong>Background:</strong> Model for end-stage liver disease (MELD) score was originally developed to predict mortality after trans jugular intrahepatic portosystemic shunt. Hyponatremia is the most common electrolyte abnormality in end stage liver disease (ESLD). Incorporating serum sodium into MELD score increases its predictive accuracy.</p><p class="abstract"><strong>Methods: </strong>This is an observational study conducted on 50 patients of ESLD admitted from October 2012 to September 2014. Study population was divided into survivor and non-survivor groups. MELD score and MELD-Na score was calculated and compared between the groups.</p><p class="abstract"><strong>Results:</strong> Out of 50 participants, 20 (40%) died in the hospital due to cirrhosis related complications. The average age was 44.7±12.040 years in the survivor group and 54.1±9.910 years in the non-survivor group. The mean MELD score and MELD-Na score was found to be higher in non-survivors group (28.5 and 30.5) compared to survivors group (22.03 and 25.67) which was statistically very significant. Majority of the patients in survivor group had MELD score between 10-19 (43.3%) and 30-39 (36.7%). In the non-survivor group majority of patients had score of more than 20 (80%). MELD-Na score has better sensitivity (90%) compared to MELD score (80%) at a cut off value above 22. However, MELD score has better specificity (60%) compared to MELD-Na score (43.3%) at the same cut off value.</p><p class="abstract"><strong>Conclusions:</strong> MELD-Na score was higher in non-survivor group with good predictability for in-hospital mortality and there was good correlation between both the scores in terms of degree of agreement and MELD-Na score was more sensitive compared to MELD score. <strong></strong></p>2019-05-24T07:02:56-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1690Severe scoliosis in an adolescent, benefits of early detection: a case report2019-05-24T07:02:56-06:00Motssim S. HalawaniM.S.HALAWANI@GMAIL.COM<p class="abstract">Presentations of scoliosis to primary health care physicians are not rare. Challenges may arise when it comes to screening and who require treatment once diagnosed. Idiopathic scoliosis is a three-dimensional spine and trunk deformity that is considered the most common form of scoliosis in children. It commonly does not cause symptoms and may be overlooked. However, if there was progressive deformity and it remained untreated, it may cause serious complications. Apart from medical concerns, emotional and cosmetic worries due to visible deformity may lead to psychological and social effects. Despite advances in understanding scoliosis, there are still controversies when it comes to optimal screening and treatment of this condition. This case is about a thirteen years old female who presented with intermittent back symptoms and was found to have a severe form of idiopathic thoracolumbar scoliosis. Through this case, author will be discussing different aspects of scoliosis (prevalence, screening, diagnosis, and treatment options) with emphasis on psychological support and guidance to the physician on how to overcome this challenge. <strong></strong></p>2019-05-24T07:02:56-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1673Interesting case of sudden unilateral blindness in a teenager: role of psychological intervention in psychogenic visual loss2019-05-24T07:02:57-06:00Motssim S. Halawanimhalawani@uj.edu.sa<p class="abstract">Visual loss complaints are commonly encountered by treating physicians, neurologist and ophthalmologists. More specifically a presentation of non-organic (psychogenic) blindness is less frequently seen but does exist and requires proper evaluation and specific skills for it to be properly managed. This case is of a 19 years old male who presented with acute monocular blindness post trauma whom he also had past psychiatric history. Post thorough assessment, no organic cause was identified, and a diagnosis of psychogenic blindness was made. Psychological therapy was beneficial in aiding return of his vision. <strong></strong></p>2019-05-24T07:02:57-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1587Generalized eczematous rash in a patient with shoe contact dermatitis: a case report2019-05-24T07:02:57-06:00Moteb K. Alotaibimoteb.alotaibi@ucm.edu.sa<p class="abstract">The id reaction, which is also known as autoeczematisation or autosensitisation dermatitis, refers to the acute development of dermatitis at a site distant from the site of the primary inflammatory cutaneous reaction. Many stimuli have been reported as causes of id reactions, including allergic contact dermatitis. The exact prevalence of id reaction is unknown, however, id reactions have been found to occur in 4%-5% of cases of dermatophyte infections and in up to 37% of patients with stasis dermatitis. This condition has no known predilection for any race, sex or age groups. Shoe dermatitis is a type of contact dermatitis developed following the contact of the foot’s skin with shoe’s parts that contain different chemical substance that harbor the potentiality to be an immune trigger. Among the potential allergens, rubber is found to be the most common shoe-related allergen reported in the literature. Other known allergens include: cements, dichromats used in tanning, dyes, anti-mildew agents, formaldehyde, and nickel eyelets or nickel arch supports. The pathogenesis of allergic contact dermatitis is a type IV, delayed-type immune response that provoked by cutaneous contacts with different material that have the ability to stimulate antigen-specific T-helper 1 (TH1) in a sensitized individual. The clinical presentation of id reaction includes acute onset of pruritic erythematous eruption with symmetrical distribution that follows the primary dermatitis by one to two weeks. Authors report a 27-year-old male who presented with generalized, symmetric pruritic and eczematous eruption following localized shoe dermatitis.</p><p> </p>2019-05-24T07:02:57-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1655Auto Immune Mixed Haemolytic anaemia: A rare presentation of SLE2019-05-24T07:02:57-06:00Mote Srikanthsrik.ushu@gmail.comS. Lokeshlokeshdr@gmail.comAnirban Duttalokeshdr@gmail.comVaishnavi Dhanashekaranlokeshdr@gmail.com<p class="abstract">Auto Immune Mixed Haemolytic Anaemia (AIHA) is defined as presence of both warm and cold antibodies against patient’s own red blood cells which is diagnosed by monospecific Direct anti-globulin test. Hereby we report a middle-aged women old women who was a known case of hypothyroidism on regular medication, presented with history of fatigability, exercise intolerance and exertional breathlessness of 1 month duration. The patient was subjected for preliminary investigations, which revealed severe anaemia with hemoglobin of 3.6 g% and an increased reticulocyte count of 12% with normal total leukocyte and platelet counts. Peripheral smear revealed anisopoikilocytosis, nucleated RBCs and schistocytes. Biochemical tests for haemolysis was evaluated which showed and elevated LDH levels (780U/L), and a reduced serum haptoglobulin levels. Liver Function test revealed a total bilirubin of 6.8mg/dl with indirect bilirubin of 5.4 mg/dl with normal liver enzymes. Baseline evaluation of Auto immune haemolytic anaemia with coombs test turned out to be positive. Patient was subjected for Mono specific DAT, Indirect Anti-globulin test (IAT) and antibody screening. Mono specific DAT showed both Anti IgG and anti C3 antibodies. IAT test was positive at 4⁰C and negative at 22⁰C and 39⁰C which confirmed that the AIHA was of mixed warm and cold type. On evaluation for connective tissue diseases, patient serum was reactive for ANA and ds-DNA and found to have Systemic Lupus Erythematosus which is a rarity and was responded to corticosteroids.</p>2019-05-24T07:02:57-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1661A rare case of duodenal carcinoid presenting as ectopic Cushing’s syndrome2019-05-24T07:02:57-06:00Siddharth Pugalendhisiddhartharjun07@gmail.comTarun Kumar Duttadrpdhivya11@gmail.comDhivya .drpdhivya11@gmail.comKiran Yadavdrpdhivya11@gmail.com<p>ACTH-dependent Cushing syndrome (CS) due to an ectopic source is responsible for approximately 10-15% cases of Cushing’s syndrome. It is associated with various tumors such as small cell lung cancer and well-differentiated bronchial or gastrointestinal neuroendocrine tumors. Many a times ectopic ACTH production is difficult to manage, and identification of the source may take many years. Hormonal diagnostics include assessments in basic conditions as well as dynamic tests, such as the high-dose dexamethasone suppression test and corticotrophin releasing hormone (CRH) stimulation test. Treatment selection depends on the type of tumor and its extent. In the case of neuroendocrine tumors, the main treatments are surgery and administration of somatostatin analogues or bilateral adrenalectomy in refractory cases and if the source remains unidentified. Here, we report a case who presented with features of Cushing’s syndrome which eventually through workup led us to a diagnosis of duodenal carcinoid producing ectopic ACTH which is extremely rare and was successfully treated.</p>2019-05-24T07:02:57-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1688Acute liver failure secondary to chronic lymphocytic leukemia2019-05-24T07:02:57-06:00Rohin Sainirohinsaini92@gmail.comArvind Mishrarohinsaini92@gmail.comKamlesh Guptarohinsaini92@gmail.comRohit Anandrohinsaini92@gmail.comUmesh Tripathirohinsaini92@gmail.comHashim .rohinsaini92@gmail.com<p class="abstract">Chronic lymphocytic leukemia is an indolent malignancy of lymphocytes commonly seen in elderly. Dissemination of malignancy is a rare cause of acute liver failure and has rarely been reported. Here we describe the case of a sixty five year old male presenting with acute liver failure. He is a diabetic with no known history of seropositive hepatits or addiction. Bone marrow and liver biopsy suggestive of chronic lymphocytic leukemia. He eventually succumbed to his illness.</p>2019-05-24T07:02:57-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1704Arachnoiditis ossificans with syringomyelia: a unique case of myelopathy2019-05-24T07:02:57-06:00Nishant Bhargavadr.nishantbhargava@gmail.comVivek Singhdr.nishantbhargava@gmail.comTameem BhatTameembhat44@gmail.comChandradev Sahucdsahu78@gmail.com<p class="abstract">Arachnoiditis ossificans (AO) is a rare disorder characterized by calcification of arachnoid membranes first described by Kaufman and Dunsmore in 1971. It is a very rare cause of spinal canal stenosis leading to neurological compromise presenting with progressive lower extremity myelopathy. It has been described to be a sequela of various conditions previous intradural surgery, myelograms, vascular malformations and adhesive arachnoiditis. Associated conditions may include syringomyelia. The imaging findings on MRI may be confusion. Preferred diagnostic method is non contrast computed tomography (CT). Surgical intervention is still controversial and can include decompression. The authors report the case of 48 years female presenting with gradually progressing paraparesis. Magnetic resonance imaging of the spine revealed a spinal cord syrinx but with an extramedullary intradural hypo-intensity. A computed tomography scan clearly demonstrated the abnormality and its extent. We present a unique case of syringomyelia resulting from spinal arachnoiditis ossificans and review the relevant literature. This case reports a unique presentation of arachnoiditis ossificans with syringomyelia in which etiology is not clear. We also highlight the difficulty is diagnosis on MRI and need of non-contrast CT.</p>2019-05-24T07:02:57-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1710Epiploic appendagitis with acute pyelonephritis: a case report2019-05-24T07:02:58-06:00Aditya Dhanawata.dhanawat@outlook.comAshim Kumar Mahalidrashimmahali32@gmail.comLalatendu Mohantylalatendumohanty3@gmail.comAmbika Prasad Mohantyambikamohanty11@gmail.com<p class="abstract">Coexistence of acute epiploic appendagitis with acute pyelonephritis is a rare occurrence. Present study report here a case of a 36-year-old male with a past history of appendectomy presenting with complaints of pain abdomen, nausea, increased frequency of micturition and dysuria. On examination, there was tenderness and guarding in the left iliac fossa. CECT abdomen revealed resolving acute epiploic appendagitis with acute pyelonephritis. He was managed conservatively with antibiotics and anti-inflammatory agents to which he responded. Thus, epiploic appendagitis is a benign self-limiting condition which when diagnosed early prevents unnecessary surgical interventions.</p>2019-05-24T07:02:58-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1721Actinomycotic lacrimal canaliculitis: a rare case report2019-05-24T07:02:58-06:00Humaira Bashirhumairasaq@yahoo.co.inAsifa Nazirasifanazir@gmail.com<p class="abstract"><em>Actinomyces israelii</em> is a gram-positive anaerobic organism commonly associated with canaliculitis in adults. Actinomyces are normal commensal bacteria in humans and primarily cause opportunistic infections during immunosuppressive state or when loss of continuity of epithelial lining in mucosa occurs. Lacrimal canaliculitis is a relatively rare condition and is undiagnosed for long periods of time. Being a relatively rare condition, it is commonly overlooked and undiagnosed for long periods of time. Primary chronic canaliculitis is an uncommon problem and <em>Actinomycosis</em> may form in up to 2% of all lacrimal disease. Here present study reports a case of lacrimal canaliculitis caused by <em>Actinomyces israelii.</em><strong><em></em></strong></p>2019-05-24T07:02:58-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1724Neonicotinoid insecticides: an emerging cause of acute pesticide poisoning2019-05-24T07:02:58-06:00Pradeep Kumar Bansaldrpkbansal22@gmail.comC. L. Nawaldrclnawal@gmail.comAradhana Singharadhanas610@yahoo.comRadheyshyam Chejaradrchejara@gmail.comSiddharth Chouhansiddharthsawansiya@gmail.comMegha Agarwalmegha.agarwal.dr.91@gmail.com<p class="abstract">Neonicotinoids are a new class of insecticides widely applied for crop protection. Information on human exposures to neonicotinoids is limited. The most common routes of exposure were ingestion (51%), dermal (44%), and ocular (11%). These insecticides act as agonists at nicotinic acetylcholine receptors, which cause insect paralysis and death the high specificity for receptors in insects was considered to possess highly selective toxicity to insects and relative sparing of mammals. However, an increasing number of cases of acute neonicotinoid poisoning have been reported in recent years. Present study report three cases presented to us with acute neonicotinoid poisoning with different manifestations including acute myocardial infarction, central nervous system (CNS) depression, and acute kidney injury, who recovered subsequently with supportive care. A detailed literature review found that respiratory, cardiovascular and certain neurological presentations are warning signs of severe neonicotinoid intoxication. Supportive treatment and decontamination are the practical methods for the management of all neonicotinoid-poisoned patients. <strong></strong></p>2019-05-24T07:02:58-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1450Multiple myeloma with primary systemic amyloidosis affecting cutaneous, gastro intestinal and cardio-vascular system2019-05-24T07:02:58-06:00Mohammed Feros A. S.ferose124@gmail.comLokesh Shanmugamlokeshsdr@gmail.com<p class="abstract">Amyloidosis refers to a group of disorders characterized by extracellular deposition of protein fibrils. Primary systemic amyloidosis is commonly due to an underlying plasma cell dyscrasia. Infiltrative amyloid cardiomyopathy is a rare cause of predominantly diastolic myocardial disease. Restrictive cardiomyopathy is the main finding in cardiac amyloidosis and results from the replacement of normal myocardial contractile elements by infiltration and interstitial deposits of amyloid, leading to alterations in cellular metabolism, calcium transport, receptor regulation, and cellular edema. Injury can also occur from circulating light chains in the absence of amyloid fibril formation. Cardiac amyloidosis should be considered in any patient presenting with congestive heart failure, preserved systolic function, and a discrepancy between a low QRS voltage on electrocardiography and an apparent left ventricular hypertrophy on sonogram. The pattern of left ventricular diastolic dysfunction changes during the course of amyloidosis and the classically described restrictive physiology occurs only in advanced stages of the disease. This is a case report where an unusual extensive cutaneous and cardiac involvement provided the sign of widespread systemic deposition of amyloid protein which eventually led to the diagnosis of multiple myeloma.</p>2019-05-24T07:02:58-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1514The vanishing phantoms2019-05-24T07:02:58-06:00Aniket Patilaniketpatil.dde.nsk@gmail.comSiddhant Jainsiddhantvandana@gmail.comSourya Acharyasouryaacharya74@gmail.comSakshi Gagnejasimplysakshi05@gmail.com<p>A50-year-old known diabetic female presented to us with gradually progressive dyspnea and swelling over both lower limbs since 15 days. She was a known case of ischemic heart disease since 3 years on medical management. On examination she was afebrile, heart rate was 128 beats/min, BP-98/52mm of Hg, JVP was raised at 11 cm of water. The respiratory rate was 30/min. Oxygen saturation was 92% while breathing in ambient air. Air entry was decreased on right inter and infra scapular areas with bi basal late inspiratory crepitations.</p>2019-05-24T07:02:58-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1644Saber sheath trachea in chronic obstructive pulmonary disease patients2019-05-24T07:02:58-06:00Lokesh Vermalokeshverma213@gmail.comHemant Boranalokeshverma213@gmail.comGovind Desailokeshverma213@gmail.comSanidhaya Taklokeshverma213@gmail.comSaber sheath trachea is defined as an anteroposterior (sagittal) diameter of intrathoracic trachea exceeding to lateral (coronal) by a ratio of 2:1 as measured at the site 1 cm above the aortic arch and the extra thoracic trachea being normal. It is most commonly seen in males and is considered to be a diagnostic sign of Chronic obstructive pulmonary disease.2019-05-24T07:02:58-06:00Copyright (c) 2019 International Journal of Advances in Medicinehttps://ijmedicine.com/index.php/ijam/article/view/1634Transforming growth factor beta signaling in hepatocellular carcinoma: as a victim or culprit?2019-05-24T07:02:58-06:00Varun Kumar Sharmavarun1.sharma@niu.edu.inCharu Tyagityagi.charu@gmail.comYugandhar P. Reddypyreddy1968@gmail.comJayanand Manjhijayanand2005@gmail.comLomas Kumar Tomarlomas.iitd@gmail.com<p class="abstract">The transforming growth factor-β (TGFβ) signalling pathway control various cellular function and play a pivotal role in tumour suppression. In contrary, overexpression of TGFβ is linked to promote the cancer development. TGFβ facilitate cell-growth and cell-differentiation process which support tumour propagation. In case of hepatocellular carcinoma (HCC), TGFβ signalling pathway is the master regulator of HCCs pathogenesis and functionally involved in the regulation of HCCs phenotype via modulating the downstream signalling pathways. In this article, we have highlighted the contradictory behaviour of TGFβ in hepatocellular carcinoma. Observations suggest that the TGFβ signalling pathway is positively correlated to the expression of genes linked with various hepatic pathological conditions, including fibrosis, cirrhosis, inflammation and cancer. TGFβ pathway play dual role as pro and anti-tumoural activities in cancer cells depending on their context.</p>2019-05-24T07:02:58-06:00Copyright (c) 2019 International Journal of Advances in Medicine